Acute and chronic anemia and short- and long-term outcome of patients with peripheral arterial disease and critical limb ischemia

• Coexistence of anemia was associated with more severe PAD.
• Patients with more severe PAD had lower rates of endovascular revascularization.
• Anemia predicts higher rates of in-hospital complications, worse short-term outcome.
• Anemia denotes higher rates of limb amputation, of short and long-term mortality.
• Anemia is driver of health-related expenditures, longer hospital stay durations.

BackgroundEvident data about the additive effect of “the fifth cardiovascular risk factor” (anemia) and peripheral arterial disease (PAD) focused on morbidity and outcome of patients with PAD are currently still missing.Methods and resultsA total of 41,882 PAD patients were included. Of these, 5566 (13.3%) suffered from anemia. Patients with anemia were older (P < 0.001), suffered more often from chronic kidney disease (P < 0.001), coronary artery disease (P < 0.001), and more severe PAD (P < 0.001). However, they received significantly less endovascular revascularizations (P < 0.001), had higher amputation rates (acute anemia: 3.7-fold, P < 0.001; nutritional, aplastic, and anemia in chronic disease: 2.9-fold, P < 0.001), higher in-hospital mortality rates (acute anemia: 6.4-fold, P < 0.001; nutritional, aplastic, and anemia in chronic disease: 4.6-fold; P < 0.001), had significantly higher in-hospital complications (P < 0.001) compared to those without anemia. During a follow-up time up to 4 years (until Dec. 31st, 2012, median 775 days, 25th–75th percentiles 469–1120 days) nutritional, aplastic, and anemia in chronic disease and acute anemia were high significant predictors of long-term mortality and amputation (each P < 0.001). Lengths of hospital stay and reimbursement costs were higher (nutritional, aplastic, and anemia in chronic disease: 2-fold higher (P < 0.001), acute anemia: 3-fold higher (P < 0.001)) than in patients without anemia.ConclusionThis study illustrates from a large, comprehensive database the association of acute, nutritional, aplastic, and anemia in chronic disease on morbidity, in-hospital treatment and complications, short- and long term outcome, and costs of patients with PAD.