- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT04427124
The CLI-AMP Registry (CLI-AMP)
Impact of Multidisciplinary Critical Limb Ischemia Team on the Utilization of Vascular Studies, Patient Management, AMPutation and Long-term Outcomes: The CLI-AMP Registry
Study Overview
Status
Intervention / Treatment
Detailed Description
It is well known from large Medicare and National Inpatient Sample databases that vascular evaluations in patients with critical limb ischemia (CLI) and at risk for amputations remains extremely low. However, this data is largely pulled from the early 2000s with a scarcity in studies from this recent decade. A recent study showed that Medicare patients from 2011 showed that 23% of patients received primary major amputation. In a recent retrospective analysis preformed at this institution, all amputation patients from 2011-2017 were evaluated for vascular work up and long-term mortality. This cohort included 698 patients with 1009 amputated specimens (major and minor). This means that this institution is preforming around 140 amputations per year, which can be considered unacceptably high. Only 50% received any form of vascular study (ankle-brachial index, doppler ultrasound, and computed tomography angiography) within the year prior to amputation. Furthermore, only 30% of patients received an angiogram within the year prior to amputation. In addition, all major amputations received histopathological analysis, which confirmed that 62% the specimens were graded with severe atherosclerosis. Even in this present decade, with the knowledge that CLI patients are not receiving proper evaluation and treatment leading to amputation which is associated with extreme mortality rates and a large economic burden, health care facilities are not improving their care.
Multidisciplinary teams are a recommendation from the American Heart Association/American College of Cardiology guidelines for managing peripheral vascular disease. Multidisciplinary team approaches in other cardiovascular diseases, such as structural heart disease, has long been validated. Literature regarding the implementation of "CLI Teams" remains scarce and not widely adopted. However, institutions that have implemented a CLI Team that engages with specialists from multiple disciplines have shown successful decrease in amputation rates and increases in vascular evaluations and revascularization in these patients. The goal for this study is to establish a hospital-based, physician and nurse led, multidisciplinary team to deliver comprehensive care to CLI patients. We believe it is important to document the experience of building a CLI Team and care protocols to provide insight and validated data for other programs to implement. The multidisciplinary team will include vascular interventionalists, hospitalists, podiatry, wound care, infectious disease, nephrology, orthopedics, pharmacists, emergency department physicians, mid-level providers, nursing staff, and vascular technologists. The ultimate goal is amputation prevention and wound healing through comprehensive vascular care and data driven patient outcomes.
Study Type
Enrollment (Anticipated)
Contacts and Locations
Study Contact
- Name: Bailey A Estes, BSN
- Phone Number: 325-207-4734
- Email: baileyann1123@gmail.com
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Sampling Method
Study Population
Description
Inclusion Criteria:
- >18 years of age
- CLI of the lower extremity
- Willingness and ability to participate in the study and meet follow-up requirements
Exclusion Criteria:
- Pregnancy
- <18 years of age
- Incarcerated patients
- Patients who receive amputations due to trauma or cancer
- Wound, gangrene, or amputation of the upper extremities
- Unwillingness or inability to participate in the study and meet follow-up requirements
Study Plan
How is the study designed?
Design Details
Cohorts and Interventions
Group / Cohort |
Intervention / Treatment |
---|---|
Prospective
Patients admitted into the hospital will receive care based on a multidisciplinary team approach and Institutional critical limb ischemia protocol.
|
All prospective patients admitted into the study will receive care based on multidisciplinary team collaboration and an institutional protocol for critical limb ischemia.
|
Retrospective
A retrospective analysis of all patients with CLI admitted to the hospital from 2017-2019 will serve as a baseline comparator for overall CLI care and long-term mortality out to 2 years will be analyzed in the retrospective cohort using the national death index.
Patients will be identified by the following ICD codes: 440.22 (ASVD of extremities with rest pain), 440.23 (ulceration), and 440.24 (gangrene).
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Change in the number of major amputations within the hospital
Time Frame: 2 years
|
Decreased percentage
|
2 years
|
Change in in-hospital and long-term mortality rates
Time Frame: 2 years
|
2 years
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Change in the percentage of non-invasive vascular evaluations in patients with CLI and at risk for amputation (ABI, DUS, CTA)
Time Frame: 2 years
|
2 years
|
|
Change in percentage of patients receiving invasive angiogram and revascularization (Endovascular or Surgical).
Time Frame: 2 years
|
2 years
|
|
Change in wound healing
Time Frame: 2 years
|
Decrease in Rutherford Classification
|
2 years
|
Change in hospital length of stay
Time Frame: 2 years
|
Decrease in days
|
2 years
|
Collaborators and Investigators
Sponsor
Collaborators
Study record dates
Study Major Dates
Study Start (ANTICIPATED)
Primary Completion (ANTICIPATED)
Study Completion (ANTICIPATED)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (ACTUAL)
Study Record Updates
Last Update Posted (ACTUAL)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
- CA10142019
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
Clinical Trials on Peripheral Arterial Disease
-
University of NebraskaNot yet recruitingPeripheral Arterial Disease | Peripheral Vascular Diseases | Peripheral Arterial Occlusive Disease | Peripheral Artery DiseaseUnited States
-
CID S.p.A.Meditrial Europe Ltd.Not yet recruitingPeripheral Arterial Occlusive Disease | Peripheral Artery DiseaseItaly
-
Marissa JarosinskiRecruitingPeripheral Arterial Occlusive Disease | Peripheral Vascular Disease | Peripheral Artery Disease | Clopidogrel, Poor Metabolism of | Artery DiseaseUnited States
-
Stanford UniversityTerminatedPAD - Peripheral Arterial Disease | PVD- Peripheral Vascular DiseaseUnited States
-
Vascuros Medical Pte LtdNovella ClinicalUnknownPeripheral Arterial Occlusive Disease | Peripheral Vascular Disease | Peripheral Artery DiseaseSingapore, Belgium, Germany
-
Western Vascular Institute, IrelandRecruitingPeripheral Arterial Occlusive DiseaseIreland
-
Jena University HospitalAngioDroid s.r.l., Bologna (Italy)CompletedPeripheral Arterial Occlusive DiseaseGermany
-
Seoul National University HospitalAstellas Pharma Korea, Inc.CompletedPeripheral Arterial Occlusive DiseaseKorea, Republic of
-
Heidelberg UniversityTerminatedPeripheral Arterial Occlusive DiseaseGermany
-
Johann Wolfgang Goethe University HospitalSuspendedPeripheral Arterial Occlusive DiseaseGermany
Clinical Trials on Multidisciplinary Team Based Care Model
-
The University of Texas Health Science Center,...DHR Health Institute for Research and DevelopmentCompletedType 2 DiabetesUnited States
-
Chinese University of Hong KongCompletedType 2 Diabetes Mellitus | DM NephropathyChina
-
University Hospital of North NorwayUniversity of TromsoActive, not recruiting
-
George Washington UniversityActive, not recruitingHeart Failure | Chronic Kidney DiseasesUnited States
-
Kaiser PermanenteGarfield Memorial FundCompletedLiver Failure | Acquired Immunodeficiency Syndrome | Stroke | Pneumonia | Diabetes Mellitus | Cancer | Pulmonary Disease, Chronic Obstructive | Respiratory Failure | Renal Failure | Dementia | Kidney Failure, Chronic | Coronary Arteriosclerosis | Cerebrovascular Accident | Failure to Thrive | Heart Failure, CongestiveUnited States
-
Cambridge Health AllianceRecruitingBehavior Disorders | Mental Disorders, Severe | Emotional DisturbancesUnited States
-
University of WashingtonPatient-Centered Outcomes Research InstituteActive, not recruitingPTSD | Physical InjuryUnited States
-
Tan Tock Seng HospitalSingapore General Hospital; University of Sydney; University of Southern Denmark and other collaboratorsActive, not recruitingCollaborative Model of Care Between Orthopaedics and Allied Healthcare Professionals Trial (CONnACT)OsteoarthritisSingapore
-
Duke-NUS Graduate Medical SchoolMinistry of Health, Singapore; The Tsao FoundationUnknownCognitive Impairment | DementiaSingapore
-
University of Kansas Medical CenterNational Cancer Institute (NCI)RecruitingObesity | Obesity, MorbidUnited States