Journal of Vascular and Endovascular Therapy

Editorial

During the last decades, the widespread adoption of endovascular techniques in vascular medicine enabled the treatment of high-risk patients with vascular diseases. In some countries, this development was partially driven by economic factors and peculiarities of the healthcare system [1]. While evidence from high quality and sufficiently powered randomized controlled trials is still lacking in some areas, international registry collaborations may provide complementary real-world data from observational studies to close the gap of knowledge concerning the treatment of patients with vascular diseases [2].

VASCUNET is a cross-border collaboration of clinical and administrative registries active in quality improvement and health services research for more than 20 years. More than 40 representatives from 26 national registries participate in this large real-world evidence network [2]. In 2014, the European society for Vascular Surgery (ESVS) VASCUNET collaboration and the Society for Vascular Surgery (SVS) Vascular Quality Initiative (VQI), involving registries in the United States and Canada, started a synergistic exchange of ideas in the International Consortium of Vascular Registries (ICVR). The ICVR is coordinated by the Medical Device Epidemiology Network (MDEpiNet), a public-private partnership with international chapters in the United States, Japan, Canada, Australia, Germany, and United Kingdom. Various reports on patient selection and treatment patterns have been published by these groups, emphasizing the differences between healthcare systems [3-6].

In light of the wide variation between countries, a critical discussion concerning the impact of healthcare and reimbursement systems and how international collaborations aim to address unwarranted variation, seems reasonable. Up to now, there is a paucity of evidence how the reimbursement systems and additional environmental factors affect the treatment-outcome relationship in cardiovascular diseases [6] Interestingly, there is evidence for an East/West divide in cardiovascular disease pointing towards disadvantages in Eastern European countries [7,8]. To further illuminate these differences, major amputation rates may serve as a super ordinated indicator of quality in vascular surgery procedures [8-10]

In Brazil, as in many other countries, we have both, a private and public health system with likely differences between both systems in terms of patient selection and treatment. Arterial diseases are prevalent and generate high demand to the Unified Health System (SUS) that has limited conditions to treat those patients [11,12]. The authors showed that for peripheral arterial occlusive disease (PAOD), there are higher amputation and mortality rates [11-13]. Other authors established satisfactory public-private partnerships, and during a period of time, showing improvement of patients suffering with vascular diseases [14]. They concluded that healthcare research is important and that costs and future public-private partnerships in vascular surgery may be a model to follow in Brazil [14].

Is "the reality" drawn by observational and randomized studies really comparable between countries concerning vascular surgery procedures? Or with other words: Is it even possible to generalize study results to the global treatment reality?

It seems challenging to answer this question, and the apparent variations in patient-selection and treatment warrant for further investigation [15]. Under ideal conditions, patients with vascular diseases should be treated evidence-based and independently from nationwide health economic considerations. Politicians and regulators may play an important role in providing the necessary environment and infrastructure.

References

1. Kreutzburg T, Peters F, Rieß HC, Hischke S, Marschall U, et al. (2020) Editor`s choice - comorbidity patterns among patients with peripheral arterial occlusive disease in germany- a trend analysis of health insurance claims data. E J Vasc Endovasc Surg 59: 59-66.
2. Behrendt CA, Venermo M, Cronenwett JL, Sedrakyan A, Beck AW, et al. (2019) VASCUNET, VQI and the International Consortium of Vascular Registries-unique collaborations for quality improvement in vascular surgery. Eur J Vasc Endovasc Surg 58: 792-793.
3. Behrendt CA, Sigvant B, Kuchenbecker J, Grima MJ, Schermerhorn M, et al. (2020) International variations and gender disparities in the treatment of peripheral arterial oclusive disease-a report from vascunet and the international consortium of vascular registries. Eur J Vasc Endovasc Surg.
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11. http://tabnet.datasus.gov.br/cgi/deftohtm.exe?idb2011/a15.def
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