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Black patients exhibit more advanced disease at time of revascularization
At the time of initial major revascularization procedures, black patients presented with more advanced disease for their initial carotid, abdominal aortic aneurysm and lower-extremity revascularizations compared with white patients, researchers wrote in the Journal of Vascular Surgery.
Current disparities in care of black patients with vascular disease may be improved by efforts to optimize medical management, they wrote.
“Racial disparities are well-documented throughout the health care system in the United States, and are particularly evident in surgery,” Peter A. Soden, MD, from the division of vascular and endovascular surgery at Beth Israel Deaconess Medical Center and Harvard Medical School, and colleagues wrote. “Over the past 20 years, and despite significant improvements in vascular surgery for carotid, AAA and peripheral artery disease, racial disparities in outcomes after vascular surgery persist across major vascular operations.”
Soden and colleagues identified the initial carotid, AAA and infrainguinal peripheral artery disease endovascular or open interventions in black and white patients using data collected from the Vascular Quality Initiative registry.
The researchers compared baseline characteristics and disease severity at the time of intervention in 76,372 non-Hispanic black and white patients.
For all operations, black patients were younger, more likely to be women, and had more insulin-dependent diabetes, hypertension, congestive HF, renal dysfunction and dialysis dependence.
Researchers found that compared with white patients, black patients were:
- less likely to be on a statin before an intervention for AAA (62% vs. 69%; P < .001) or PAD (61% vs. 67%; P < .001);
- less likely to be discharged on an antiplatelet and statin regimen after these procedures (AAA, 60% vs. 64%; P = .01; PAD, 64% vs. 67%; P < .001);
- more likely to present with more severe disease, including higher proportions of symptomatic carotid disease (36% vs. 31%; P < .001), symptomatic or ruptured AAA (27% vs. 16%; P < .001), and chronic limb-threatening ischemia (73% vs. 62%; P < .001); and
- more likely to present with concurrent iliac artery aneurysms at the time of AAA repair (elective open AAA repair, 46% vs. 26%; P < .001; elective endovascular aneurysm repair, 38% vs. 23%; P < .001).
“We believe this gap in severity of disease at the time of initial intervention is related to the prevalence and management of risk factors, medical management and a possible delay in receiving vascular care,” the researchers wrote. “Our analysis highlights the disparity in optimal medical management for patients undergoing AAA and PAD intervention both before operation and at discharge. This important preventative measure warrants further quality improvement efforts.” – by Dave Quaile
Disclosures: The authors report no relevant financial disclosures.