Differential Outcomes Of Patients With Peripheral Arterial Disease (PAD) When Index Presentation Is The Emergency Department (ED) Rather Than The Office Setting, A Potential Indicator Of Healthcare Disparity
Jeffery Indes, MD1, John Denesopolis, MD2, Varun Dalmia, BS1, Antoine Pham, BS1, Peng Zhau, MD1, Maria Coluccio, MD1, Evan Lipsitz, MD, MBA1.
1Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA, 2Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA.
ObjectiveHealthcare disparities predispose patients to seek emergency room care rather than care within the office setting. Ideal management of PAD involves early referral to a vascular specialist. The aim of this study was to compare the characteristics and clinical outcomes of patients presenting with an initial diagnosis of PAD in the outpatient setting to those presenting in the ED. MethodsTriNetX “Diamond” network is a large U.S. claims database containing data from 190 million patients. Between 2001-2021 patients were identified by ICD-10 diagnosis codes for claudication or CLI and separated into 2 groups based on setting of index diagnosis as ER or office. The 2 groups underwent propensity matching. Primary endpoints included major adverse limb event (MALE) defined as BKA, AKA, hip disarticulation and major adverse cardiac event (MACE) defined as death, MI, or stroke. Results34,481 patients with claudication presented to the ED and 14,627 presented in the office. There were significantly higher rates of hypertension, metabolic disorder, ischemic heart disease, diabetes, obesity and COPD in the ED group. An increased incidence of MALE was seen in the ED group before propensity matching [3.44% vs. 2.25%, (p < 0.0001)] and was persistently elevated after propensity matching [3.10% vs. 2.24%, (p < 0.0001)]. MACE was also seen at increased rates in the ED group before and after propensity matching [34.73% vs. 22.39%, (p < 0.0001)] and [36.19% vs. 22.04%, (p < 0.0001)], respectively. 28,207 patients with CLI presented to the ED and 7,710 presented in the office. There were significantly higher rates of hypertension, metabolic disorder, ischemic heart disease, diabetes, obesity, and COPD in CLI patients presenting to the ED. Again, MALE was seen at a higher rate in the ED before and after propensity matching [13.19% vs. 11.03%, (p < 0.0001)] and [12.23% vs. 10.93%, (p < 0.0001)], respectively. In CLI MACE was associated with ER initial visit before and after propensity matching [41.48% vs. 33.94%, (p < 0.0001)] and [46.34% vs. 33.10%, (p < 0.0001)], respectively. ConclusionsPatients with PAD in the ER group had significantly higher serious comorbidities. We found a significantly higher rate of MALE and MACE in claudicants and CLI patients presenting to the ED, suggesting these patients may be at a disadvantage to access to follow up care.
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