Contemporary Interventional Management of Peripheral Artery Disease in Ontario
Bibliographic record
Abstract
Introduction: Despite increasing international recognition of the morbidity associated with peripheral artery disease (PAD), our understanding of PAD epidemiology and management outcomes in the province of Ontario remains based on studies of limited contemporary external validity. The overarching objective of this thesis was to characterize contemporary interventional management of PAD in Ontario. Methods: Using Ontario administrative databases, we first performed a time series analysis of the trends in hospitalization for PAD. Second, we performed a validation study to estimate the positive predictive value (PPV) of diagnostic, procedure and physician claims coding to identify lower extremity open and endovascular revascularization for PAD in Ontario administrative databases. Third, we evaluated temporal trends of lower extremity revascularizations and amputation for PAD, in the context of a rising diabetes prevalence. Finally, in a cohort study, we compared the long-term effectiveness of open and endovascular revascularization approaches with respect to amputation-free survival (AFS) and related outcomes.Results: Hospitalizations for PAD have not significantly declined (decline of 0.068/100,000 Ontarians per quarter from 2006 to 2019, p=0.10). Open and endovascular revascularization for PAD can be reliably identified in Ontario administrative databases (PPV 83% to 96%). As the prevalence of diabetes has increased, the use of revascularization for PAD has increased (from 75.1 in 2002 to 90.7/100,000 person-years in 2019; unadjusted rate ratio (RR) [95% CI]=1.11 [1.08-1.14]; diabetes-adjusted RR [95% CI]=1.00 [0.98-1.03]), and a decrease in amputations for PAD has been attenuated (from 49.5 in 2002 to 45.4/100,000 person-years in 2019; unadjusted RR [95% CI]=0.81 [0.78-0.84]; diabetes-adjusted RR [95% CI]=0.65 [0.63-0.67]). Endovascular compared to open revascularization was associated with better AFS (HR [95% CI]= 0.94 [0.91-0.98]) in the full cohort, but not among subgroups with diabetes, tissue loss or isolated infrainguinal disease. Conclusions: Hospitalizations for PAD have not significantly decreased. Ontario databases can be reliably used to identify revascularization for PAD. The rising prevalence of diabetes has influenced the temporal trends in revascularization and amputation for PAD. Open revascularization may not offer a long-term benefit over endovascular revascularization. These data answer a need for real-world evidence to guide decision-making around PAD care.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.004 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".