PVI For PAD More Common in Blacks, Higher Burden of Comorbidities Drives Worse Outcomes

In the U.S., Black adults bear a disproportionate burden of peripheral artery disease (PAD). A nationwide analysis has found that Black adults had a substantially higher population-level incidence of peripheral endovascular intervention (PVI) and were more likely to experience major amputation or death in the first year after PVI than White adults. The findings were published June 13 in Circulation.

Anna K. Krawisz, MD, Eric A. Secemsky MD, MSc, FACC, et al., used data collected from 2016 to 2018 from fee-for-service (FFS) Medicare beneficiaries ≥66 years of age to examine racial differences in the incidence of PVI and its outcomes. Claims codes were used to identify patients’ first inpatient or outpatient PVI. In addition, age- and sex-standardized risks of the composite outcome of death and major amputation within one year of PVI were examined by race.

A total of 40,393,58 FFS Medicare patients were included in the initial analysis to determine the population-level incidence of PVI. For evaluating outcomes, 141,401 patients who underwent PVI but did not have at least one year of follow-up data were excluded.

Results showed a higher population-level incidence of PVI among Black beneficiaries compared with White beneficiaries (928 per 100,000 vs. 530 per 100,000; risk ratio, 1.75; 95% confidence interval [CI], 1.73-1.77; p<0.01) over the three-year study. Additionally, Black adults compared with White adults who underwent PVI were typically younger (mean age, 74.5 years vs. 76.4 years; p<0.01) and female (52.8% vs. 42.7%; p<0.01). They also had a higher burden of comorbidities: diabetes (70.6% vs. 56.0%; p<0.01), chronic kidney disease (67.5% vs. 56.6%; p<0.01) and heart failure (47.4% vs. 41.7%; p<0.01).

Black adults were more likely to undergo PVI for chronic limb-threatening ischemia than White adults (61.0% vs. 49.9%; p<0.01). The study showed a strong association between Black race and the composite outcome of death and major lower limb extremity amputation within one year (odds ratio, 1.21; 95% CI, 1.16-1.25).

The authors note that in addition to a higher population-level incidence of PVI and adverse events, Black adults are less likely than White adults to be prescribed key medical therapies for PAD, such as statins. They go on to state, “This [study] suggests a critical need for targeted, upstream intervention to reduce the disproportionate development of PAD in the Black population, to reduce the disproportionate development of advanced disease within the PAD population, and to improve outcomes for patients with advanced PAD who require PVI.”

Clinical Topics: Dyslipidemia, Heart Failure and Cardiomyopathies, Vascular Medicine, Atherosclerotic Disease (CAD/PAD), Nonstatins, Novel Agents, Statins, Acute Heart Failure

Keywords: Hydroxymethylglutaryl-CoA Reductase Inhibitors, Odds Ratio, Race Factors, Incidence, Inpatients, Confidence Intervals, Follow-Up Studies, Outpatients, Medicare, Peripheral Arterial Disease, Amputation, Heart Failure, Diabetes Mellitus, Renal Insufficiency, Chronic, Lower Extremity

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