Racial And Regional Disparities In The Utilization Of Preventative Care Strategies Among Patients With Peripheral Artery Disease And Diabetes

Eid, Mark A.; Mehta, Kunal; Barnes, James H.; Wanken, Zachary J.; Gladders, Barbara; Austin, Andrea M.; Creager, Mark A.; Bonaca, Marc P.; Feinberg, Mark W.; Stone, David H.; Goodney, Philip P.

doi:10.1016/j.avsg.2021.01.012

Cited by 1 publication

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“…We used regional rates of concomitant diagnosis of PAD and diabetes as a proxy for the regional rate of CLI 18 . Among the Medicare cohort, CLI prevalence rates per 1000 Medicare patients were as follows: Northeast 2.63, South 2.52, Midwest 2.95, West 1.98.…”

Section: Resultsmentioning

confidence: 99%

“…Finally, CLI is a heterogenous disease not readily identified using administrative data sources 10,11 . However, using a broad definition of concomitant PAD and diabetes has been reported previously, and likely provides a conservative estimate of CLI-related vascular outcomes 18 …”

Section: Discussionmentioning

confidence: 98%

“…10,11 However, using a broad definition of concomitant PAD and diabetes has been reported previously, and likely provides a conservative estimate of CLI-related vascular outcomes. 18…”

Section: Discussionmentioning

confidence: 99%

“…We used regional rates of concomitant diagnosis of PAD and diabetes as a proxy for the regional rate of CLI. 18…”

Section: Regional Amputation Ratesmentioning

confidence: 99%

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Participation in a Chronic Limb Threatening Ischemia Randomized Trial Is Inversely Correlated With Regional Amputation Rate in Limb Threatening Ischemia Patients

et al. 2021

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Objective: The National Health Service demonstrated that regions of the United Kingdom with the highest number of patients enrolled in research studies had the lowest risk-adjusted mortality when patients were admitted to the hospital. Our goal was to investigate if this correlation was evident for patients with chronic limb threatening ischemia (CLI) treated in the United States (US). Accordingly, we examined correlations among sites participating in the Best Endovascular versus best Surgical Therapy in patients with Critical (BEST-CLI) trial, a multicenter, National Institute of Health-sponsored, international randomized controlled trial (RCT) comparing revascularization strategies in patients with CLI, and regional rates of major amputation from CLI. Methods: We measured regional participation in the BEST-CLI trial by evaluating trial participation and enrollment rosters. To determine regional rates of lower limb amputation, we queried the Medicare database (2007–2016) for patients with concurrent peripheral arterial disease (PAD) and diabetes, then assessed how many had lower extremity amputations. Correlation of regional amputation rates with distribution of BEST-CLI sites in four US geographical regions was calculated using Pearson's correlation coefficients. Simple regression equations were used to calculate the significance of these correlation coefficients. Results: Of 9,231,909 CLI patients, 342,406 underwent amputation in the Medicare dataset. Amputation rates per 1000 CLI patients differed by region (South 40.42, Midwest 40.12, West 34.81, Northeast 31.14). There were 116 US vascular centers, selected by volume and expertise that participated in BEST-CLI with the following distribution: South (n = 30, 26%), Midwest (n = 26, 22%), West (n = 29, 25%), and Northeast (n = 31, 27%). There was a negative correlation between the number of amputations per 1000 for Medicare CLI patients with diabetes and PAD and the number of BEST-CLI sites in the region which trended toward significance (Pearson R= −0.61, P = 0.39). Conclusions: Amputation rate among Medicare CLI patients is inversely correlated with US BEST-CLI site distribution. Higher participation in clinical research, especially within large RCTs, may be a marker of optimal PAD management.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 98%

“…10,11 However, using a broad definition of concomitant PAD and diabetes has been reported previously, and likely provides a conservative estimate of CLI-related vascular outcomes. 18…”

Section: Discussionmentioning

confidence: 99%

“…We used regional rates of concomitant diagnosis of PAD and diabetes as a proxy for the regional rate of CLI. 18…”

Section: Regional Amputation Ratesmentioning

confidence: 99%

See 2 more Smart Citations

Participation in a Chronic Limb Threatening Ischemia Randomized Trial Is Inversely Correlated With Regional Amputation Rate in Limb Threatening Ischemia Patients

et al. 2021

Self Cite

View full text Add to dashboard Cite

show abstract

Racial And Regional Disparities In The Utilization Of Preventative Care Strategies Among Patients With Peripheral Artery Disease And Diabetes

Cited by 1 publication

References 0 publications

Participation in a Chronic Limb Threatening Ischemia Randomized Trial Is Inversely Correlated With Regional Amputation Rate in Limb Threatening Ischemia Patients

Participation in a Chronic Limb Threatening Ischemia Randomized Trial Is Inversely Correlated With Regional Amputation Rate in Limb Threatening Ischemia Patients

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