Peripheral vascular interventions for PAD: “Confronting the healthcare disparities”

Anna K Krawisz

In a study recently published in Circulation, researchers found that Black adults underwent significantly more endovascular peripheral vascular interventions (PVI), were treated for more advanced disease and were also more likely to experience adverse outcomes following PVI procedures, including amputation and death. Interventional News spoke to two of the authors—Eric A Secemsky and Anna K Krawisz (Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Boston, USA)—about their motivations for carrying out the study, the results it yielded, and where this research might lead.

Asked what led them to study race-related disparities in PVI treatment and outcomes, Secemsky and Krawisz explain that the Vascular Research section at the Smith Center is “deeply invested in improving care for patients with peripheral artery disease (PAD).” This, they assert, means “confronting the healthcare disparities that are prevalent in the vascular field.” PVI is now a common means of revascularisation and, therefore, the authors state their desire to “to understand whether racial disparities exist in different aspects of PVI”, knowing, as they do from their study, that “Black adults have a higher prevalence of PAD than white adults and they are more likely to have adverse outcomes such as amputation.” Moreover, the authors sought to identify what underpins the differences in outcomes for Black versus white patients.

Eric A Secemsky

Secemsky and Krawisz relay their findings as follows— Black race was associated with worse one-year outcomes following PVI, with adjustment for age and sex, owing, in large part, to the “disproportionate burden of advanced comorbidities among Black adults.” A further finding, the authors communicate, was that Black adults have more advanced PAD than white adults when they are referred for PVI.

“These results were not necessarily surprising,” they admit, but it is nonetheless, “critically important” that the vascular community be aware of them, given how much PVI is used to manage symptomatic PAD. However, what did surprise them was how few patients, regardless of race, received guideline-directed medical therapies following PVI—”we would have expected that medical therapy would be optimised prior to moving towards revascularisation,” they state.

The authors’ hope for their findings is that the vascular community better understands how “critically important” it is to detect, and effectively treat, comorbidities early. This is particularly crucial in Black adults, they affirm, so as “to reduce health disparities and improve limb outcomes.”

Regarding where this research will lead, Secemsky and Krawisz convey that they “continue to untangle the interplay between many types of disparities that impact care and outcomes in PAD, including poverty, gender, regional wealth, and geographic location.” Krawisz will give special focus to better understanding why women, like Black patients, tend to present for treatment with more advanced PAD, and why, when they require amputation, it is, generally, “more proximal”. Her research programme, she explains, will centre around PAD management for female patients. She reports that clinical trials in PAD “tend to underrepresent female patients”.


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