Impact of serious mental illness on clinical outcomes among Veterans with critical limb ischemia

Abstract: Background: A significant burden of mental illness is prevalent among veterans with critical limb ischemia (CLI). We designed a retrospective study using a large veteransʼ database to study the impact of mental illness on mortality and amputation among veterans with CLI. Methods: This retrospective cohort study included veterans aged 18 years and older with CLI utilizing the Veterans Health Administration health care network in the US. Two cohorts were created: with serious mental illness (major depression, obsessive compulsive disorder, post-traumatic stress disorder, bipolar disorder and schizophrenia) and without serious mental illness. Propensity matching method was used to analyze mortality and amputation outcomes. Analyses were performed using SAS software. Results: Total of 119686 CLI veterans from VA database were included. 97.6% were male and 66.8% were white, 84.1% were >65 years old and 77.6% had BMI <30. Veterans with mental illness had higher prevalence of comorbidities such as coronary artery disease (55% vs 31%), chronic kidney disease (10% vs 5%), chronic obstructive pulmonary disease (11% vs 4%) and diabetes (61% vs 36%) compared with those without mental illness. Mortality was high in this CLI population (76.5% at the end of follow up) and significantly higher in veterans with mental illness compared with those without mental illness (81.8% vs 75.3%, p<0.0001, OR: 1.47, CI: 1.42-1.53). After propensity matching, CLI veterans with mental illness had higher odds of amputation compared with those without mental illness (OR: 1.31, CI: 1.21-1.43). Conclusion: Among veterans with CLI, mental illness is associated with a significantly higher mortality and amputations, highlighting the need for comprehensive management strategies addressing both physical and mental health to improve prognosis in this vulnerable population.

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