Peripheral artery disease (PAD) affects millions of Americans, but certain demographics face significant disparities in the quality of care they receive. Research highlights that Black patients, those with low socioeconomic status, and residents of rural areas are less likely to receive essential medical services. These services include consultations with primary care providers or vascular specialists and lower extremity revascularization, which can help prevent amputations. These disparities have severe implications, as evidenced by lower rates of limb-saving procedures and higher rates of major amputations among these vulnerable groups.
Impact on Vulnerable Populations
From July 2010 to December 2019, significant disparities in vascular care were observed among Black patients and those with lower socioeconomic status or living in rural areas. These individuals were less likely to attend outpatient visits with vascular specialists or receive lower extremity arterial testing and revascularization before major lower extremity amputations. The study published in Circulation: Cardiovascular Quality and Outcomes revealed that only 55.1% of the 73,237 patients who underwent major amputation had seen an outpatient vascular subspecialist beforehand. Furthermore, 82.1% received lower extremity arterial testing, yet merely 38.7% underwent revascularization before amputation.
Black patients, individuals from lower socioeconomic backgrounds, and rural residents demonstrated significant delays in seeking vascular care. This delay often resulted in shorter periods between the diagnosis of PAD and subsequent amputations. The data underscores that these patients are likely to seek medical attention only when the disease has progressed significantly. Consequently, fewer options remain for limb salvage at these advanced stages of PAD. Such disparities reflect systemic issues within healthcare delivery, particularly in the accessibility and quality of vascular care for these populations.
Systemic Challenges and Their Consequences
Dr. Alexander Fanaroff has emphasized that every amputation due to chronic limb-threatening ischemia (CLTI) represents a failure in providing quality care aimed at preventing such outcomes. He asserts that health systems, policymakers, and other stakeholders must prioritize enhancing access to PAD-specific care for the most vulnerable patients. Addressing and eliminating the disparities in pre-amputation care is depicted as crucial in preventing unnecessary amputations. The current healthcare framework demands immediate interventions to ensure that high-quality vascular care is both available and accessible to all patients, regardless of race, location, or socioeconomic status.
The disparities highlighted in the study stress the need for systemic changes in how CLTI care is designed and delivered. These changes are essential for promoting equitable access and quality treatment. For Black, rural, and low-income patients, improving PAD care requires dismantling barriers that hinder timely and effective medical interventions. A focus on preventative care practices, early diagnosis, and access to specialized vascular treatments can significantly reduce the rate of preventable amputations among these populations. Therefore, concerted efforts from various stakeholders in healthcare are necessary to achieve these objectives.
Call for Reformation in Healthcare Delivery
Peripheral artery disease (PAD) impacts millions of Americans, however, some demographic groups experience significant disparities in the quality of care. Studies reveal that African American patients, individuals with low socioeconomic status, and those living in rural areas are less frequently provided with crucial medical services. They often miss out on consultations with primary care physicians or vascular specialists, as well as lower extremity revascularization procedures that can help avert amputations. These healthcare disparities have dire consequences. Vulnerable groups show lower rates of limb-saving surgeries and higher incidences of major amputations, severely impacting their quality of life. Efforts to bridge these gaps are essential to ensuring equitable healthcare access and improving outcomes for all PAD patients. Addressing these disparities requires targeted policies and increased awareness to promote better management and treatment, ultimately reducing the disproportionate rates of severe complications in these populations.