Study Shows Black Patients Present With More Advanced Disease at Time of Initial Major Vascular Interventions

 

October 18, 2017—In Journal of Vascular Surgery (JVS), Peter A. Soden, MD, et al published findings online ahead of print from a study that aimed to evaluate differences in initial vascular intervention between black and white patients. The investigators concluded that black patients present with more advanced disease at the time of the initial major vascular operation.

According to the investigators, many studies have demonstrated racial disparities after major vascular surgery, but few have identified the reasons for these disparities, and those that did, often lacked clinical granularity.

As summarized in JVS, the investigators identified black and white patients' initial carotid, abdominal aortic aneurysm (AAA), and infrainguinal peripheral artery disease (PAD) interventions in the Vascular Quality Initiative (VQI) registry from 2009 to 2014. The study only included white and black patients, excluding those of Hispanic ethnicity, as well as those with asymptomatic PAD or a history of previous ipsilateral interventions. They compared baseline characteristics and disease severity at time of intervention on a national and regional level.

Identifying 76,372 patients (9% black), including 35,265 carotid (5% black), 17,346 AAA (5% black), and 23,761 PAD interventions (18% black), the investigators found the following:

  • For all operations, black patients were younger, more likely women, and had higher rates of insulin-dependent diabetes, hypertension, congestive heart failure, renal dysfunction, and dialysis dependence.
  • Black patients were less likely to be on a statin before AAA (62% vs 69%; P < .001) or PAD intervention (61% vs 67%; P < .001) and 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]).
  • Black patients presented 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).
  • Black patients more often presented 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]).

Efforts to control risk factors, identify and treat arterial disease in a timely fashion, and optimize medical management among black patients may provide an opportunity to improve current disparities, advised the investigators in JVS.

 

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