{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,7]],"date-time":"2026-11-07T14:31:38Z","timestamp":1794061898608,"version":"4.8.0"},"reference-count":27,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"24","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2021,12,21]]},"abstract":"<jats:sec xml:lang=\"en\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p xml:lang=\"en\">The optimal treatment strategy for patients with chronic limb\u2010threatening ischemia (CLTI) is often unclear. Frailty has emerged as an important factor that can identify patients at greater risk of poor outcomes and guide treatment selection, but few studies have explored its utility among the CLTI population. We examine the association of a health record\u2010based frailty measure with treatment choice and long\u2010term outcomes among patients hospitalized with CLTI.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Methods and Results<\/jats:title>\n                    <jats:p xml:lang=\"en\">We included patients aged &gt;65\u00a0years hospitalized with CLTI in the Medicare Provider Analysis and Review data set between October 1, 2009 and September 30, 2015. The primary exposure was frailty, defined by the Claims\u2010based Frailty Indicator. Baseline frailty status and revascularization choice were examined using logistic regression. Cox proportional hazards regression was used to determine the association between frailty and death or amputation, stratifying by treatment strategy. Of 85\u00a0060 patients, 35\u00a0484 (42%) were classified as frail. Frail patients had lower likelihood of revascularization (adjusted odds ratio [OR], 0.78; 95% CI, 0.75\u20120.82). Among those revascularized, frailty was associated with lower likelihood of surgical versus endovascular treatment (adjusted OR, 0.76; CI, 0.72\u20120.81). Frail patients experienced increased risk of amputation or death, regardless of revascularization status (revascularized: adjusted hazard ratio [HR], 1.34; CI, 1.30\u20121.38; non\u2010revascularized: adjusted HR, 1.22; CI, 1.17\u20121.27). Among those revascularized, frailty was independently associated with amputation or death irrespective of revascularization strategy (surgical: adjusted HR, 1.36; CI, 1.31\u20121.42; endovascular: aHR, 1.29; CI, 1.243\u20121.35).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p xml:lang=\"en\">Among patients hospitalized with CLTI, frailty is an important independent predictor of revascularization strategy and longitudinal adverse outcomes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/jaha.121.023138","type":"journal-article","created":{"date-parts":[[2021,12,16]],"date-time":"2021-12-16T05:51:30Z","timestamp":1639633890000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":32,"title":["Association of Frailty With Treatment Selection and Long\u2010Term Outcomes Among Patients With Chronic Limb\u2010Threatening Ischemia"],"prefix":"10.1161","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6937-4041","authenticated-orcid":false,"given":"Neel M.","family":"Butala","sequence":"first","affiliation":[{"name":"Division of Cardiovascular Medicine Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology Beth Israel Deaconess Medical Center Boston MA"},{"name":"Cardiology Division Department of Medicine Massachusetts General HospitalHarvard Medical School Boston MA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9060-0648","authenticated-orcid":false,"given":"Aishwarya","family":"Raja","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Medicine Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology Beth Israel Deaconess Medical Center Boston MA"},{"name":"Columbia University Irving Medical Center New York City NY"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiaman","family":"Xu","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Medicine Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology Beth Israel Deaconess Medical Center Boston MA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6592-6141","authenticated-orcid":false,"given":"Jordan B.","family":"Strom","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Medicine Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology Beth Israel Deaconess Medical Center Boston MA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4278-964X","authenticated-orcid":false,"given":"Marc","family":"Schermerhorn","sequence":"additional","affiliation":[{"name":"Division of Vascular and Endovascular Surgery Department of Surgery Beth Israel Deaconess Medical Center Boston MA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8332-8439","authenticated-orcid":false,"given":"Joshua A.","family":"Beckman","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Medicine Department of Medicine Vanderbilt University Medical Center Nashville TN"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4888-2431","authenticated-orcid":false,"given":"Mehdi H.","family":"Shishehbor","sequence":"additional","affiliation":[{"name":"Harrington Heart and Vascular InstituteCase Western Reserve University School of Medicine and University Hospitals Cleveland Medical Center Cleveland OH"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Changyu","family":"Shen","sequence":"additional","affiliation":[{"name":"Biogen, Inc. Cambridge MA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0564-4468","authenticated-orcid":false,"given":"Robert W.","family":"Yeh","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Medicine Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology Beth Israel Deaconess Medical Center Boston MA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3861-3163","authenticated-orcid":false,"given":"Eric A.","family":"Secemsky","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Medicine Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology Beth Israel Deaconess Medical Center Boston MA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_1_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvs.2015.07.065"},{"key":"e_1_3_1_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvs.2019.02.016"},{"key":"e_1_3_1_4_2","doi-asserted-by":"publisher","DOI":"10.1161\/cir.0000000000000471"},{"key":"e_1_3_1_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvs.2015.09.055"},{"key":"e_1_3_1_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.avsg.2017.06.141"},{"key":"e_1_3_1_7_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCOUTCOMES.118.005273"},{"key":"e_1_3_1_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvs.2012.04.074"},{"key":"e_1_3_1_9_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00268-006-0242-y"},{"key":"e_1_3_1_10_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvs.2008.07.062"},{"key":"e_1_3_1_11_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvs.2018.08.169"},{"key":"e_1_3_1_12_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmjqs-2018-008661"},{"key":"e_1_3_1_13_2","doi-asserted-by":"publisher","DOI":"10.1111\/imj.14159"},{"key":"e_1_3_1_14_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamacardio.2019.3511"},{"key":"e_1_3_1_15_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvs.2017.04.048"},{"key":"e_1_3_1_16_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCINTERVENTIONS.118.006778"},{"key":"e_1_3_1_17_2","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.118.009724"},{"key":"e_1_3_1_18_2","doi-asserted-by":"publisher","DOI":"10.1097\/MLR.0000000000000729"},{"key":"e_1_3_1_19_2","doi-asserted-by":"publisher","DOI":"10.1093\/aje\/kwx257"},{"key":"e_1_3_1_20_2","doi-asserted-by":"publisher","DOI":"10.1097\/00005650-199801000-00004"},{"key":"e_1_3_1_21_2","doi-asserted-by":"publisher","DOI":"10.7326\/M17-1058"},{"key":"e_1_3_1_22_2","doi-asserted-by":"publisher","DOI":"10.1080\/03610910902859574"},{"key":"e_1_3_1_23_2","doi-asserted-by":"publisher","DOI":"10.1080\/01621459.1999.10474144"},{"key":"e_1_3_1_24_2","doi-asserted-by":"publisher","DOI":"10.1093\/gerona\/gls119"},{"key":"e_1_3_1_25_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCINTERVENTIONS.118.007009"},{"key":"e_1_3_1_26_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvs.2018.12.060"},{"key":"e_1_3_1_27_2","doi-asserted-by":"publisher","DOI":"10.1002\/pds.3674"},{"key":"e_1_3_1_28_2","doi-asserted-by":"publisher","DOI":"10.1093\/gerona\/56.3.M146"}],"container-title":["Journal of the American Heart Association"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ahajournals.org\/doi\/full\/10.1161\/JAHA.121.023138","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,5,13]],"date-time":"2024-05-13T07:18:13Z","timestamp":1715584693000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ahajournals.org\/doi\/10.1161\/JAHA.121.023138"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,12,21]]},"references-count":27,"journal-issue":{"issue":"24","published-print":{"date-parts":[[2021,12,21]]}},"alternative-id":["10.1161\/JAHA.121.023138"],"URL":"https:\/\/doi.org\/10.1161\/jaha.121.023138","relation":{},"ISSN":["2047-9980"],"issn-type":[{"value":"2047-9980","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,12,21]]},"assertion":[{"value":"2021-07-05","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2021-11-08","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2021-12-16","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e023138"}}