Lower extremities amputaitons are decreasing!

Amputations can be prevented -  amputation rates are decreasing!!!
It is important to know that the methods to reduce amputation and improve the quality of life are measurably effective in some countries such as America. During the last 25 years of our service at our institution in Hyderabad, the amputation rate has come down, but still the patients are coming for advice very late. That means we need to encourage the govt hospital doctors at primary care centers to recognize these problems early and treat the risk factors before they are unmanageable. That is the best way to control the epidemic cardiovascular diseases. Bypasses and balloon angioplasties will help to some extent but the larger populations can be benefited by the identification and modification of the risk factors. It may be worth developing risk modification clinics across the state to address this issue and improve the quality of life. The Aarogyasree scheme is very helpful to the people but it is going to be better if they also spend money for the development of the risk modification clinics.


Temporal Trends and Geographic Variation of Lower-Extremity Amputation in Patients With Peripheral Artery DiseaseResults From U.S. Medicare 2000–2008
W. Schuyler Jones, MD; Manesh R. Patel, MD; David Dai, PhD; Sumeet Subherwal, MD, MBA; Judith Stafford, MS; Sarah Calhoun, BS; Eric D. Peterson, MD, MPH
J Am Coll Cardiol. 2012;60(21):2230-2236. doi:10.1016/j.jacc.2012.08.983
Abstract
Objectives This study sought to characterize temporal trends, patient-specific factors, and geographic variation associated with amputation in patients with lower-extremity peripheral artery disease (LE PAD) during the study period.
Background Amputation represents the end-stage failure for those with LE PAD, and little is known about the rates and geographic variation in the use of LE amputation.
Methods By using data from the Centers for Medicare & Medicaid Services (CMS) from January 1, 2000, to December 31, 2008, we examined national patterns of LE amputation among patients age 65 years or more with PAD. Multivariable logistic regression was used to adjust regional results for other patient demographic and clinical factors.
Results Among 2,730,742 older patients with identified PAD, the overall rate of LE amputation decreased from 7,258 per 100,000 patients with PAD to 5,790 per 100,000 (p < 0.001 for trend). Male sex, black race, diabetes mellitus, and renal disease were all independent predictors of LE amputation. The adjusted odds ratio of LE amputation per year between 2000 and 2008 was 0.95 (95% CI: 0.95–0.95, p < 0.001).
Conclusions From 2000 to 2008, LE amputation rates decreased significantly among patients with PAD. However, there remains significant patient and geographic variation in amputation rates across the United States.