O-227 - TRENDS IN THE EPIDEMIOLOGY AND MANAGEMENT OF CHRONIC VENOUS DISEASE IN THE UK

TOPIC:
Venous Diseases (including Malformations)
AUTHORS:
Salim S. (Imperial College London ~ London ~ United Kingdom) , Mazidi M. (Imperial College London ~ London ~ United Kingdom) , Fernandez-Crespo R. (Imperial College London ~ London ~ United Kingdom) , Collin E. (Servier ~ Paris ~ France) , Chirol J. (Servier ~ Paris ~ France) , Onida S. (Imperial College London ~ London ~ United Kingdom) , Davies A.H. (Imperial College London ~ London ~ United Kingdom)
Introduction:
Previous epidemiological estimates for Chronic Venous Disease (CVD) suggest that 19% of the adult population have Varicose Veins (VV) whilst 0.4% have a history of Venous Leg Ulceration (VLU) [1]. However, since studies generated these estimates, there have been initiatives to improve venous care. Initiatives in the UK include national guidelines for venous disease in 2014 and subsequent changes to national healthcare commissioning criteria [2]. Longitudinal studies are required to evaluate the impact of such initiatives with respect to trends in the management and epidemiology of CVD. This research aims to investigate changes in both the epidemiology and management of CVD in the UK.
Methods:
This is a retrospective, longitudinal study evaluating routinely collected data from electronic healthcare records (Clinical Practice Research Datalink/CPRD) [3]. Participants aged 18 years or over, with anonymised research quality data in CPRD were eligible for inclusion. Electronic diagnostic codes (Read codes) were used to identify participants with the clinical manifestations of CVD, as described in the Clinical Etiology Anatomy Pathophysiology (CEAP) classification [4]. Primary and secondary care data were used to delineate the management of CVD with respect to prescriptions, referrals, and operative procedures. During the 10-year study period, from 2008-2018, the number of eligible participants ranged from 2.3-4.2 million annually. For each year, an annual period prevalence and incidence were calculated. Descriptive statistics were used to evaluate the management of the CVD cohort.
Results:
The annual period prevalence of symptomatic VV, was 2.02% and 1.94% in 2008 and 2018 respectively. This is reflected in the annual incidence rate of VV per 100,000 which decreased from 1632 to 1575 in 2008 and 2018 respectively. Conversely, the annual period prevalence of active VLU decreased from 0.76% to 0.43% in 2008 and 2018 respectively. The annual incidence of active VLU decreased from 451 to 241 new cases per 100,000 in 2008 and 2018. Over the 10-year interval, the use of compression in the CVD cohort increased from 2.8% in 2008 to 8.05% in 2018. Over the same period of time, the number of CVD patients being referred to vascular surgeons doubled from 4.54% to 10.24%. During this time, the proportion of those with venous skin changes undergoing surgical/endovenous ablation increased from 3.11% in 2008 to 4.09% in 2018, with a peak of 5.19% in 2015.
Conclusion:
Previous estimates have indicated that 19% of the population have VV, however 2% of people in this cohort had VV with symptoms severe enough to seek out care. The epidemiology of VV has remained static over this 10-year period whilst VLU has decreased. Concomitantly, the use of compression, specialist referrals, and surgical/endovenous ablations, has increased. The current reduction in VLU prevalence may relate to improvements in CVD care, possibly because of changes in national guidance.
References:
[1] Salim S, Machin M, Patterson BO, Onida S, Davies AH. Global Epidemiology of Chronic Venous Disease: A Systematic Review With Pooled Prevalence Analysis. Ann Surg. 2021 Dec 1;274(6):971-976. doi: 10.1097/SLA.0000000000004631. PMID: 33214466. [2] Carradice, D., Forsyth, J., Mohammed, A., Leung, C., Hitchman, L., Harwood, A.E., Wallace, T., Smith, G.E., Campbell, B. and Chetter, I. (2018), Compliance with NICE guidelines when commissioning varicose vein procedures. BJS Open, 2: 419-425. https://doi.org/10.1002/bjs5.95 [3] Emily Herrett, Arlene M Gallagher, Krishnan Bhaskaran, Harriet Forbes, Rohini Mathur, Tjeerd van Staa, Liam Smeeth, Data Resource Profile: Clinical Practice Research Datalink (CPRD), International Journal of Epidemiology, Volume 44, Issue 3, June 2015, Pages 827-836, https://doi.org/10.1093/ije/dyv098 [4] Lurie F, Passman M, Meisner M, Dalsing M, Masuda E, Welch H, Bush RL, Blebea J, Carpentier PH, De Maeseneer M, Gasparis A, Labropoulos N, Marston WA, Rafetto J, Santiago F, Shortell C, Uhl JF, Urbanek T, van Rij A, Eklof B, Gloviczki P, Kistner R, Lawrence P, Moneta G, Padberg F, Perrin M, Wakefield T. The 2020 update of the CEAP classification system and reporting standards. J Vasc Surg Venous Lymphat Disord. 2020 May;8(3):342-352. doi: 10.1016/j.jvsv.2019.12.075. Epub 2020 Feb 27. Erratum in: J Vasc Surg Venous Lymphat Disord. 2021 Jan;9(1):288. PMID: 32113854.