Treatment with evidence-based antiplatelet and statin therapies in peripheral artery disease (PAD) patients differ by socioeconomic status, and can be largely explained by the clinical practice at which the patient receives care, according to a study published in the Journal of the American College of Cardiology.

Additional Resources PINNACLE Registry ACCF/AHA Compilation of 2005 and 2011 Management of Patients with Peripheral Artery Disease Guideline Recommendations ACCF/AHA/ACR/SCAI/ SIR/SVM/SVN/SVS 2010 Performance Measures for Adults with Peripheral Artery Disease CardioSmart for Your Patients: About Peripheral Arterial Disease

The study used data from the NCDR's outpatient registry, the PINNACLE Registry®, and looked at 62,690 PAD patients from 61 sites. Compared with the highest socioeconomic status quintile (median income >$60,868), results showed that PAD patients in the lowest socioeconomic status quintile (median income <$34,486) were treated less often with statins (72.5 percent vs. 85.8 percent; rate ratio 0.84 [0.83-0.86]; P<0.001) and antiplatelet therapy (79.0 percent vs. 84.6 percent; rate ratio 0.93 [95 percent CI: 0.91-0.94]; P<0.001).

After controlling for site variations, the differences were markedly attenuated: statins (adjusted rate ratio: 0.97 [0.95-0.99]; P=0.003) and antiplatelet therapy (adjusted rate ratio 0.98 [0.97-1.00]; P=0.012). In addition, additional adjustment for patients' clinical characteristics had minimal impact with slight further attenuation.

The authors note that disparities research on PAD has previously been limited, but the "present study confirms findings similar to other cardiac disease states in that use of secondary prevention treatment for PAD was lower among those of low socioeconomic status." Moving forward, the authors suggest that "initiatives to reduce disparities in medication treatment for PAD should target practices with high proportions of low socioeconomic status patients."

"This study is important for several reasons," said Frederick A. Masoudi, MD, FACC. "First, it illustrates the importance of having a mechanism like the PINNACLE Registry to measure the quality of care in outpatient cardiovascular practice. Secondly, it shows that even in practices dedicated to quality that care can be improved. Finally, it adds to the growing body of evidence that shows that disparities in care along socioeconomic lines reflect where patients receive care and that addressing these disparities will best be achieved by elevating the quality of care in practices that serve these vulnerable populations."

Keywords: Heart Diseases, Vulnerable Populations, Secondary Prevention, Outpatients, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Income, Peripheral Arterial Disease, Social Class, United States

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