A recent study reveals ongoing disparities in the treatment of peripheral artery disease (PAD) and its more severe form, chronic limb-threatening ischemia (CLTI), contributing to higher amputation rates in the United States.
The study, titled “Racial, Socioeconomic, and Geographic Disparities in Preamputation Vascular Care for Patients With Chronic Limb-Threatening Ischemia,” tracked patients in the year leading up to their amputation. It investigated the impact of race, socioeconomic status (SES), and geographic location on preamputation vascular care, finding that Black patients, those with low SES, and individuals living in rural areas face disproportionately higher rates of major lower extremity amputations. These outcomes may be linked to limited access to specialized CLTI care.
Among the 73,237 patients who underwent major lower extremity amputation, key findings include:
- 55.1% had an outpatient vascular subspecialist visit,
- 82.1% underwent lower extremity arterial testing,
- 38.7% received lower extremity revascularization in the year before their amputation.
Notably, Black patients were less likely to have an outpatient vascular specialist visit or revascularization compared to their White counterparts. Additionally, patients with low SES or residing in rural areas had significantly reduced access to outpatient vascular specialist visits when compared to those with higher SES or living in urban locations.
Researchers concluded that Black race, rural residence, and low SES are significant factors contributing to inadequate preamputation care, particularly for those with CLTI. The findings underscore the need for comprehensive, multilevel interventions aimed at ensuring equitable access to vascular care to prevent amputations.
Dr. Alexander Fanaroff, MD, MHS, study coauthor and an interventional cardiologist at the University of Pennsylvania, emphasized the importance of addressing these disparities. “Every patient who undergoes amputation for CLTI represents a failure in delivering quality care designed to prevent such outcomes,” Fanaroff stated. “This includes revascularization, a treatment with proven benefits in preventing major lower extremity amputations. It’s crucial to focus not just on identifying unnecessary procedures, but also on recognizing the vital procedures that were not performed.”
Fanaroff called on healthcare systems, policymakers, and stakeholders to work toward facilitating easier access to PAD-specific care, especially for the most vulnerable patient populations. This study serves as a crucial step in addressing the systemic barriers that contribute to these disparities.
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