Evaluating Receipt of Optimal Medical Therapy Among Structurally Disadvantaged Groups Undergoing Amputation

Area of Science:

• Vascular Surgery
• Health Disparities
• Public Health

Background:

• Optimal medical therapy (OMT) for peripheral artery disease (PAD) is crucial for reducing major amputation and mortality rates.
• Key components of OMT include antiplatelet therapy, high-intensity statins, and blood pressure management.
• Existing disparities in OMT receipt are known, but the impact of neighborhood socioeconomic status, measured by the area deprivation index (ADI), remains unclear.

Purpose of the Study:

• To investigate the association between neighborhood socioeconomic status (high ADI) and non-Hispanic Black (NHB) race with the receipt of OMT in patients undergoing major lower extremity amputation.
• To determine if patients residing in disadvantaged neighborhoods are less likely to receive OMT before amputation.

Main Methods:

• A retrospective review of 354 patients who underwent major lower extremity amputation between 2015 and 2019 at two academic healthcare systems.
• Exposure variables included high ADI (≥60th percentile) and NHB race.
• The primary outcome was receipt of OMT (antiplatelet agent and high-intensity statin), assessed via multivariable logistic regression.

Main Results:

• Overall, only 25.7% of patients received OMT despite vascular surgery consultation.
• High ADI was not associated with OMT receipt (aOR 0.72, 95% CI 0.42-1.24).
• NHB race was also not associated with OMT receipt; findings were consistent across different facility types.

Conclusions:

• Neighborhood economic status, as indicated by ADI, does not appear to influence OMT receipt in patients facing major amputation.
• Despite the lack of observed socioeconomic disparities, the overall low rate of OMT is suboptimal.
• There is a critical need to evaluate care processes and develop quality measures to enhance OMT delivery for PAD patients at risk of amputation.