Journal article
Sex Differences in Management and Outcomes of Critical Limb Ischemia in the Medicare Population
Circulation. Cardiovascular interventions, Vol.13(10), pp.e009459-e009459
10/01/2020
DOI: 10.1161/CIRCINTERVENTIONS.120.009459
PMCID: PMC7583656
PMID: 33079598
Abstract
Background:
Evidence about sex differences in management and outcomes of critical limb ischemia (CLI) is conflicting.
Methods:
We identified Fee-For-Service Medicare patients within the 5% enhanced sample file who were diagnosed with new incident CLI between 2015 and 2017. For each beneficiary, we identified all hospital admissions, outpatient encounters and procedures, and pharmacy prescriptions. Outcomes included 90-day mortality and major amputation.
Results:
Incidence of CLI declined from 2.80 (95% CI, 2.72-2.88) to 2.47 (95% CI, 2.40-2.54) per 1000 person from 2015 to 2017, P0.01. Incidence was lower in women compared with men (2.19 versus 3.11 per 1000) but declined in both groups. Women had a lower prevalence of prescription of any statin (48.4% versus 52.9%, P0.001) or high-intensity statins (15.3% versus 19.8%, P0.01) compared with men. Overall, 90-day revascularization rate was 52%, and women were less likely to undergo revascularization (50.1% versus 53.6%, P0.01) compared with men. Women had a similar unadjusted (9.9% versus 10.3%, P=0.5) and adjusted 90-day mortality (adjusted rate ratio, 0.98 [95% CI, 0.85-1.12], P=0.7) compared with men. Over the study period, unadjusted 90-day mortality remained unchanged for men (10.4% in 2015 to 9.9% in 2017, P-for trend=0.3), and women (9.5% in 2015 to 10.6% in 2017, P-for trend=0.2). Men had higher unadjusted (12.9% versus 8.9%, P0.001) and adjusted risk of 90-day major amputation (adjusted rate ratio, 1.30 [95% CI, 1.14-1.48], P0.001). One-third of patients with CLI underwent major amputation without a diagnostic angiogram or trial of revascularization in the preceding 90 days regardless of the sex.
Conclusions:
Women with new incident CLI are less likely to receive statin or undergo revascularization at 90 days compared with men. However, the differences were small. There was no difference in risk of 90-day mortality between both sexes.
Details
- Title: Subtitle
- Sex Differences in Management and Outcomes of Critical Limb Ischemia in the Medicare Population
- Creators
- Amgad Mentias - Cleveland ClinicMary Vaughan-Sarrazin - Cleveland ClinicMarwan Saad - Brown UniversitySaket Girotra - Cleveland Clinic
- Resource Type
- Journal article
- Publication Details
- Circulation. Cardiovascular interventions, Vol.13(10), pp.e009459-e009459
- Publisher
- Lippincott Williams & Wilkins
- DOI
- 10.1161/CIRCINTERVENTIONS.120.009459
- PMID
- 33079598
- PMCID
- PMC7583656
- ISSN
- 1941-7640
- eISSN
- 1941-7632
- Number of pages
- 8
- Grant note
- VA Office of Rural Heath T32 HL007121 / NIH National Research Service Award institutional grant; United States Department of Health & Human Services; National Institutes of Health (NIH) - USA NIA R01AG055663-01 / National Institute on Aging; United States Department of Health & Human Services; National Institutes of Health (NIH) - USA; NIH National Institute on Aging (NIA) Health Services Research and Development Service (HSRAMP;D) of the Department of Veterans Affairs
- Language
- English
- Date published
- 10/01/2020
- Academic Unit
- Health Management and Policy; Cardiovascular Medicine; General Internal Medicine; Internal Medicine
- Record Identifier
- 9984359690202771
Metrics
11 Record Views