Abstract 13391: Exploring Prognostic Implications of Socioeconomic Status in Patients With Peripheral Arterial Disease

Abstract

Introduction: This systematic review sought to describe the prognostic implications of SES on clinical outcomes in patients undergoing vascular interventions for claudication and critical limb threatening ischemia (CLTI). Hypothesis: Methods: Studies were systematically searched across 5 databases from inception to June 2021. Studies focused on patients with claudication or CLTI undergoing open, endovascular, or hybrid procedures. Studies were included if SES was documented and associated with a clinical outcome. Two independent reviewers selected studies for inclusion, extracted data, and assessed risk of bias using ROBINS-I and Newcastle-Ottawa scales. Extracted data included study and clinical characteristics, demographics, interventions, outcome measured, and association of SES with the clinical outcomes. Results: Thirty four studies met our inclusion criteria and addressed the impact of SES in patients undergoing interventions for PAD, with 8 articles including only claudication patients, 2 including only CLTI patients, and 24 including a combination of both groups. The way SES was defined varied across studies, with some describing it in relation to insurance status (n=14), household income (n=13), income in area of living (n=8), income in the hospital’s area (n=1) and employment status (n=1). Low SES was associated with higher rates of amputation as a primary intervention, higher rates of above the knee amputation compared to below the knee amputation, higher 30 day postoperative death, longer lengths of stay, higher surgical sites infections, amputations following primary interventions, in-hospital complications, long term major adverse limb events and long term amputation rates. Given the amount of heterogeneity that was present in the designs, populations, and comparators among the included studies, we were unable to statistically pool data across trials. Conclusions: Our qualitative findings suggest that low SES is associated with significant adverse outcomes in patients with PAD including higher rates of primary amputation, post-operative mortality, length of stay, among others. Reasons for these disparities should be explored to identify solutions for decreasing and eliminating these health inequities.