Not all mental disorders matter equally in peripheral arterial disease: Dementia drives prognosis and care disparities.

BACKGROUND AND AIMS: Mental Disorders are increasingly recognized as modifiers of cardiovascular outcomes, yet their differential impact in peripheral arterial disease (PAD) remains poorly understood. We investigated the prevalence, treatment patterns, and prognostic relevance of depression, anxiety disorders, and dementia in patients hospitalized for PAD. METHODS: In this nationwide cohort study based on claims data from AOK - Die Gesundheitskasse, 99,415 patients hospitalized for PAD between January 1, 2019 and December 31, 2020 were identified. Treatment patterns and clinical outcomes were assessed using multivariable-adjusted analyses and Cox regression models. RESULTS: Overall, 47% of patients hospitalized for PAD had concomitant depression, anxiety, or dementia (D-A-D). Patients with these mental disorders were more frequently female, presented with more advanced PAD stages, and had a higher cardiovascular risk profile. However, marked heterogeneity between mental conditions was observed. Dementia was associated with the most pronounced treatment disparities, including substantially lower rates of revascularization and statin therapy despite more advanced disease at presentation. Dementia further emerged as a strong independent predictor of all-cause mortality (HR 1.57-1.62; p < 0.001) and amputation and/or death (HR 1.49-1.56; p < 0.001). In contrast, depression showed only modest associations with adverse outcomes after adjustment, while anxiety disorders were not consistently associated with increased risk. CONCLUSIONS: Mental Disorders in PAD are not prognostically homogeneous. Dementia identifies a particularly vulnerable and undertreated PAD population characterized by substantial therapeutic disparities and markedly adverse clinical outcomes, highlighting an important and underrecognized gap in vascular care.