Low and High Ankle-Brachial Index Are Both Associated with Mortality in German Nursing Home Residents-The Five-Year Follow-Up of the "Allo-Study" Cohort

Anna Dorn; Bernhard Dorweiler; Wael Ahmad; Spyridon Mylonas; Ingrid Becker; Payman Majd

doi:10.3390/jcm12134411

Low and High Ankle-Brachial Index Are Both Associated with Mortality in German Nursing Home Residents-The Five-Year Follow-Up of the "Allo-Study" Cohort

J Clin Med. 2023 Jun 30;12(13):4411. doi: 10.3390/jcm12134411.

Authors

Anna Dorn¹, Bernhard Dorweiler², Wael Ahmad², Spyridon Mylonas², Ingrid Becker³, Payman Majd¹

Affiliations

¹ Vascular Surgery Department, Protestant Hospital, 51465 Bergisch Gladbach, Germany.
² Vascular Surgery Department, University Hospital of Cologne, 50937 Cologne, Germany.
³ Institute of Medical Statistics and Computational Biology, University Hospital of Cologne, 50937 Cologne, Germany.

Abstract

Peripheral arterial disease (PAD) is associated with high cardiovascular morbidity and mortality. We aimed to examine this relation in a population that tends to be under-represented in research on the topic. In a prospective observational cohort study, residents of 45 nursing homes in Germany were screened for pathological ankle-brachial index (ABI) and observed for five years. Of 1333 participants (median age 84 years), 55.5% had a pathological ABI (≤0.9 or >1.4) on one or both legs. 84.7% of the probands with a low ABI (indicating PAD) had no previously known PAD diagnosis. The five-year mortality was 73.0%. Mortality was higher in individuals with a pathological ABI (76.5%) than in those with a normal ABI (68.7%, p = 0.003). An ABI > 1.4 was associated with a higher mortality (79.4%) than a reduced (74.7%) or normal ABI (68.7%, p = 0.011). Pathological ABI values were associated with an increase in mortality after correction for age, sex and all recorded comorbidities, including cardiac disease. Although PAD is highly prevalent in nursing home residents, it is underdiagnosed and undertreated. In the study cohort, both high and low ABI were important predictors of mortality. PAD deserves more attention in this high-risk population.

Keywords: aged; ankle-brachial index; epidemiology; nursing homes; peripheral arterial disease; screening.

Grants and funding

This research was supported by the Alloheim Senioren-Residenzen SE in terms of the organization of the appointments in the residences, contribution to the data collection by nursing home staff and transport expenses. Members of the study team did not receive any personal benefit. The authors had sole responsibility for all methodological decisions.