2023-04-24 09:44:09
24. April 2023
According to an analysis of AOK patient data, women with the circulatory disorder PAOD in particular are undersupplied. In the follow-up period of the study, the survival rate was surprisingly higher for women and the amputation rate lower than for men. This is proven by a study by the University Hospital Münster, which was awarded a science prize.
In Germany, people who suffer from peripheral arterial occlusive disease (PAD), a circulatory disorder in the pelvic and leg arteries as a result of arteriosclerosis (vascular calcification), are unfortunately often not treated in accordance with the guidelines and are therefore inadequately cared for. This is particularly true for women with PAD in the advanced disease stage of “critical extremity ischemia”. This is the worrying result of a study of AOK health insurance data on around 200,000 inpatients treated for PAOD. At this stage of PAD, several risk factors such as diabetes mellitus, high blood pressure, smoking and lipid metabolism disorders (high LDL cholesterol) as well as concomitant diseases such as chronic heart or kidney failure often come together.
“In our analysis, we were able to show that the inadequate care of men and women with PAD encompasses diagnosis as well as therapy and follow-up care. However, this is even more pronounced in women than in men,” reports the first author of the study, Dr. re. of course Lena Makowski from the Clinic for Cardiology I at the University Hospital Münster. Her work, published in the “European Heart Journal” in 2022, revealed these deficits in the care of patients with PAD and was awarded the Science Prize of the Josef- Freitag Foundation (endowment 10,000 euros) awarded.
Women receive less vascular diagnostics and therapy
The starting point for the health care analysis of the Münster researcher and her team was the realization that scientific work in recent decades has shown gender-specific differences in the frequency and course of the disease in PAD patients, but women are significantly underrepresented in randomized controlled studies. Looking at the AOK data, consider that PAD in the stage of critical extremity ischaemia usually with high blood pressure (90%) and in about half of those affected with other risk diseases such as diabetes (54%), dyslipidemia (58%) or concomitant diseases such as coronary artery disease heart disease (CHD) (58%), chronic cardiac insufficiency (45%) or renal insufficiency (49%), a far-reaching undersupply of this patient group is an alarming signal.
The analysis of the AOK patient data from the beginning of 2010 to the end of 2017 and a follow-up up to 2018 showed that women in this PAD stage and hospitalization were on average almost eight years older than men (81 vs. 74 years), but they were suffered from critical extremity ischaemia more frequently and were treated in hospital less frequently overall. At their first hospitalization for PAD, women were less likely to receive diagnostic angiography (67% vs. 70%) or restoration of blood flow (revascularization) via the femoral artery catheter or open surgery (61% vs. 65%). “These diagnostic and therapeutic measures are urgently recommended in the PAD stage of critical extremity ischemia. Revascularization is the standard therapy here and is crucial to prevent amputation,” emphasizes biologist and healthcare researcher Dr. Makowski.
Also fewer lipid-lowering drugs and blood thinners for women
The study also suggests that there is a supply deficit in drug therapy at the expense of women. examined by Dr. Makowski and her team measured the prescription rate of the lipid-lowering drugs (statins) and oral blood thinners (platelet inhibitors/oral anticoagulants) recommended in the guidelines to prevent serious complications such as heart attacks and strokes as well as vascular complications in the legs. Even for both sexes overall, the prescription rate after treatment in the hospital, i.e. after a confirmed diagnosis of PAD, was too low (statins: 57%; blood thinners: 71%). However, the prescription rate for women was again significantly lower than for men (statins: 51% vs. 62%; blood thinners: 68% vs. 73%).
Better long-term survival and fewer amputations in women
Surprisingly, in the nine-year follow-up period of the study, the survival rate in women with PAD was higher and the amputation rate lower than in men, despite the poorer care.
“However, our health care analysis also shows that PAOD is underestimated by doctors and is often diagnosed too late or not at all and often not treated in accordance with the guidelines,” says Dr. Makowski. This “dramatically” worsens the prognosis of those affected. The reasons for this are diverse. In particular, the multimorbidity of PAD patients, who have several organ and vascular diseases at the same time, contributes to this and presents physicians with challenges, for example in drug therapy. In addition, women often have longer asymptomatic courses of the disease or atypical symptoms, which delays the diagnosis and thus the timely therapy of PAD. Further research work at the University Hospital in Münster should address this problem in order to improve the care of PAD patients.
DThe results of the study are to be implemented in the new guidelines for the care of PAD. In Germany, four to five million people suffer from circulatory disorders in the vessels (arteriosclerosis). PAD is associated with a high risk of heart attack and stroke.
literature
Makowski L. et al., Sex-related differences in treatment and outcome of chronic limb-threatening ischaemia: a real-world cohort, European Heart Journal:
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