Outcomes of Multidisciplinary and Evidence-Based Management of Chronic Limb Threatening Ischemia Patients: The Impacts of Protocol-Based Care Processes

Abstract

Background: Chronic limb-threatening ischemia (CLTI) represents the late stage of atherosclerotic peripheral arterial disease (PAD). Similar to atherosclerosis in other vascular beds, it is preceded by a long-standing early disease and pre-disposing conditions. Thus, the care of this patient population is theoretically best delivered by a multidisciplinary team. The authors studied the outcomes of a multidisciplinary, well-structured, and evidence-based protocol that might influence better outcomes for CLTI patients. Materials and Methods: The present study was a retrospective study done in a single center. Between January 2018 and December 2020, data were reviewed from CLTI patients that received the multidisciplinary, well-structured, and evidence-base protocol for the treatment of CLTI. The primary outcome was the perioperative clinical outcome of the patients. The secondary outcomes were the 1-year clinical outcome and the admission cost for vascular operation. Results: Two hundred thirty CLTI cases between January 2018 and December 2020 were retrospectively reviewed. Of the 230 cases, 87.9% were elderly (older than 60-years-old) with significant comorbidities including diabetes (74.3%) and hypertension (74.8%). The protocol implementation resulted in clinical outcomes in terms of both major adverse cardiac event (MACE) and major adverse limb event (MALE) at 1.3% and 6.52%, respectively. The survival rates at 1-and 2-years post-revascularization were 84.3% and 74.1%, and the 1-year follow-up MACE and MALE were 6.08% and 12.2%, respectively. Moreover, the protocol statistically improved the quality of life as measured by EuroQoL group-5 Dimensions-5 Levels (EQ-5D-5L) utility score. The median 1-year mean EQ-5D-5Q score increased from 0.332 to 0.863. The cost of the treatments was significantly higher with the increasing severities of CLTI. Conclusion: A multidisciplinary, well-structured, and evidence-based protocol may potentially be effective in improving the quality of care among CLTI patients, both in terms of clinical outcomes and overall health status. Keywords: Peripheral arterial disease (PAD); Chronic limb-threatening ischemia (CLTI); Multidisciplinary and evidence-based protocol