Clinician specialty does not contribute to worse outcomes in peripheral artery disease

Socioeconomic factors, but not clinician specialty, are associated with poorer outcomes among patients with peripheral artery disease (PAD), suggests a study.

A team of investigators included 1,768 patients with at least one PAD-related encounter in our health system and fee-for-service Medicare and classified them based on the specialty of the clinician (ie, cardiologist, podiatrist, surgeon, primary care, or other) providing a plurality of PAD-coded care in the year prior to index encounter.

Major adverse vascular events (MAVE; a composite of all-cause mortality, myocardial infarction, stroke, lower extremity revascularization, and lower extremity amputation) were the primary outcome.

Of the patients, 30.0 percent were Black, 23.9 percent were Medicaid dual-enrolment eligible, and 31.1 percent lived in rural areas.

Patients receiving their care from podiatrists had the highest 1-year rates of MAVE (34.4 percent; p<0.001), hospitalization (65.9 percent; p<0.001), and amputations (22.6 percent; p<0.001). However, clinical specialty no longer correlated with outcomes after adjustment.

Notably, patients who were Medicaid dual-eligible had higher adjusted risks of mortality (adjusted hazard ratio [aHR], 1.54, 95 percent confidence interval [CI], 1.11‒2.14) and all-cause hospitalization (aHR, 1.20, 95 percent CI, 1.03‒1.40), while those who were Black had a higher adjusted risk of amputation (aHR, 1.49, 95 percent CI, 1.03‒2.15).

“The effects of clinician specialty and socioeconomic status were likely attenuated by the fact that all patients in this study had health insurance,” the investigators said. “[T]hese analyses require confirmation in a more representative cohort.”