PMID- 34052213
OWN - NLM
STAT- MEDLINE
DCOM- 20210909
LR  - 20221207
IS  - 1097-6744 (Electronic)
IS  - 0002-8703 (Linking)
VI  - 239
DP  - 2021 Sep
TI  - The association of healthcare disparities and patient-specific factors on 
      clinical outcomes in peripheral artery disease.
PG  - 135-146
LID - S0002-8703(21)00143-5 [pii]
LID - 10.1016/j.ahj.2021.05.014 [doi]
AB  - BACKGROUND: PAD increases the risk of cardiovascular mortality and limb loss, and 
      disparities in treatment and outcomes have been described. However, the 
      association of patient-specific characteristics with variation in outcomes is 
      less well known. METHODS: Patients with PAD from Duke University Health System 
      (DUHS) between January 1, 2015 and March 31, 2016 were identified. PAD status was 
      confirmed through ground truth adjudication and predictive modeling using 
      diagnosis codes, procedure codes, and other administrative data. Symptom 
      severity, lower extremity imaging, and ankle-brachial index (ABI) were manually 
      abstracted from the electronic health record (EHR). Data was linked to Centers 
      for Medicare and Medicaid Services data to provide longitudinal follow up. 
      Primary outcome was major adverse vascular events (MAVE), a composite of 
      all-cause mortality, myocardial infarction (MI), stroke, lower extremity 
      revascularization and amputation. RESULTS: Of 1,768 patients with PAD, 31.6% were 
      asymptomatic, 41.2% had intermittent claudication (IC), and 27.3% had chronic 
      limb-threatening ischemia (CLTI). At 1 year, patients with CLTI had higher rates 
      of MAVE compared with asymptomatic or IC patients. CLTI and Medicaid dual 
      eligibility were independent predictors of mortality. CLTI and Black race were 
      associated with amputation. CONCLUSIONS: Rates of MAVE were highest in patients 
      with CLTI, but patients with IC or asymptomatic disease also had high rates of 
      adverse events. Black and Medicaid dual-eligible patients were disproportionately 
      present in the CLTI subgroup and were at higher risk of amputation and mortality, 
      respectively. Future studies must focus on early identification of high-risk 
      patient groups to improve outcomes in patients with PAD.
CI  - Copyright (c) 2021. Published by Elsevier Inc.
FAU - Narcisse, Dennis I
AU  - Narcisse DI
AD  - Division of Cardiology, Duke University Health System, Durham, NC.
FAU - Ford, Cassie B
AU  - Ford CB
AD  - Department of Population Health Sciences, Duke University, Durham, NC.
FAU - Weissler, E Hope
AU  - Weissler EH
AD  - Duke Clinical Research Institute, Durham, NC; Division of Vascular and 
      Endovascular Surgery, Duke University Health System, Durham, NC.
FAU - Lippmann, Steven J
AU  - Lippmann SJ
AD  - Department of Population Health Sciences, Duke University, Durham, NC.
FAU - Smerek, Michelle M
AU  - Smerek MM
AD  - Department of Population Health Sciences, Duke University, Durham, NC.
FAU - Greiner, Melissa A
AU  - Greiner MA
AD  - Department of Population Health Sciences, Duke University, Durham, NC.
FAU - Hardy, N Chantelle
AU  - Hardy NC
AD  - Department of Population Health Sciences, Duke University, Durham, NC.
FAU - O'Brien, Benjamin
AU  - O'Brien B
AD  - Department of Population Health Sciences, Duke University, Durham, NC.
FAU - Sullivan, R Casey
AU  - Sullivan RC
AD  - Division of Cardiology, Washington University School of Medicine, St. Louis, MO.
FAU - Brock, Adam J
AU  - Brock AJ
AD  - Division of Cardiology, University of North Carolina, Chapel Hill, NC.
FAU - Long, Chandler
AU  - Long C
AD  - Division of Vascular and Endovascular Surgery, Duke University Health System, 
      Durham, NC.
FAU - Curtis, Lesley H
AU  - Curtis LH
AD  - Department of Population Health Sciences, Duke University, Durham, NC; Duke 
      Clinical Research Institute, Durham, NC.
FAU - Patel, Manesh R
AU  - Patel MR
AD  - Division of Cardiology, Duke University Health System, Durham, NC; Duke Clinical 
      Research Institute, Durham, NC.
FAU - Jones, W Schuyler
AU  - Jones WS
AD  - Division of Cardiology, Duke University Health System, Durham, NC; Duke Clinical 
      Research Institute, Durham, NC. Electronic address: schuyler.jones@duke.edu.
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20210527
PL  - United States
TA  - Am Heart J
JT  - American heart journal
JID - 0370465
SB  - IM
MH  - Amputation, Surgical/*statistics & numerical data
MH  - Asymptomatic Diseases/epidemiology
MH  - Black People/statistics & numerical data
MH  - Female
MH  - Health Services Needs and Demand
MH  - Healthcare Disparities/*organization & administration
MH  - Humans
MH  - *Lower Extremity/blood supply/surgery
MH  - Male
MH  - Medicaid/statistics & numerical data
MH  - Middle Aged
MH  - Mortality
MH  - Myocardial Infarction/*epidemiology
MH  - *Peripheral Arterial Disease/complications/diagnosis/epidemiology/physiopathology
MH  - Risk Factors
MH  - Stroke/*epidemiology
MH  - United States/epidemiology
MH  - *Vascular Surgical Procedures/methods/statistics & numerical data
EDAT- 2021/05/31 06:00
MHDA- 2021/09/10 06:00
CRDT- 2021/05/30 20:41
PHST- 2021/02/16 00:00 [received]
PHST- 2021/05/20 00:00 [accepted]
PHST- 2021/05/31 06:00 [pubmed]
PHST- 2021/09/10 06:00 [medline]
PHST- 2021/05/30 20:41 [entrez]
AID - S0002-8703(21)00143-5 [pii]
AID - 10.1016/j.ahj.2021.05.014 [doi]
PST - ppublish
SO  - Am Heart J. 2021 Sep;239:135-146. doi: 10.1016/j.ahj.2021.05.014. Epub 2021 May 
      27.