Young Women and Men With Critical Limb Ischemia: Distinct Risk Profiles with Gaps in Quality of Care and Amputation Outcomes
Presenter
Ahmad Z Arham, M.D., Yale New Haven Health, New Haven, CT
Ahmad Z Arham, M.D.1, Kristie Harris, PhD2, Yulanka Castro, MD, FSCAI3, Aaron E. Brice, M.D.4, Zain Ahmed, MD, MPH5, Carlos I. Mena-Hurtado, M.D., FSCAI6 and KIm Smolderen, PhD5, (1)Yale New Haven Health, New Haven, CT, (2)Yale New Haven Hospital/Yale University, New Haven, CT, (3)University Hospitals Harrington Heart & Vascular Institute, Cleveland, OH, (4)University of Arkansas for Medical Sciences, New Haven, --, (5)-, New Haven, CT, (6)Yale University, New Haven, CT
Keywords: Critical Limb Ischemia/Chronic Limb-threatening Ischemia (CLT/CLTI), Diversity Equity and Inclusion (DEI), Peripheral Artery Disease (PAD), Peripheral Vascular Disease (PVD) and Women's Health
Background
Age and sex differences in critical limb ischemia (CLI) are not well defined. It is also unknown whether age/sex related health care deficiencies exist for CLI patients, which have previously been observed for coronary artery disease.
Methods
The study cohort was derived using discharge data from the National Inpatient Sample database for years 2011 to 2017. Hospitalizations in patients with CLI were identified and divided into four groups: men <65 years, women <65 years, men ≥65 years, women ≥65 years (reference). Sociodemographics and comorbidities were compared between age/sex groups along with in-hospital revascularization rates, and minor and major amputations.
Results
Relative to the other age/sex groups, both women and men <65 years were more likely to be non-white and belong to the lower income quartile. Women <65 years had the highest prevalence of diabetes, obesity and depression. After adjustment for race and comorbidities, of all age/sex groups both men and women <65 years had the highest odds of experiencing major and minor amputation, but were less likely to receive endovascular and surgical revascularization compared with women ≥65 years.
Conclusions
Both women and men <65 years carried a higher amputation risk in the setting of a CLI admission, but were less likely to get access to revascularization options as with older age/sex groups. Younger patients with CLI present with a distinct clinical risk profile, and a better understanding of mechanisms that explain gaps in their care and outcomes is needed to tailor novel care paradigms to their unique risk profile and needs.
