Hispanics adults hospitalized for treatment of symptoms of peripheral artery disease (PAD) were more likely to access this care by going to the emergency room (ER), and they experienced longer and more expensive hospitalizations than non-Hispanic white patients with PAD, according to preliminary research to be presented at the American Heart Association's Quality of Care and Outcomes (QCOR) Research Scientific Sessions 2021. The meeting will be held virtually Monday, Nov. 15, 2021, in conjunction with the Association's Scientific Sessions 2021. QCOR is a premier global exchange of the latest advances in quality of care and outcomes research in cardiovascular disease and stroke for researchers, health care professionals and policymakers.
Peripheral artery disease, or PAD, affects 8.5 million Americans and shares many of the same risk factors as coronary artery disease, including high blood pressure, high cholesterol, smoking, type 2 diabetes and older age. PAD occurs when blood flow is restricted in the lower legs and can reduce a person's mobility and ability to perform routine, daily living activities. The condition increases the risk for heart attack and stroke.
The Hispanic population is one of the fastest growing ethnic groups in the U.S., and prior studies have shown worse outcomes among Hispanic adults with PAD, including higher rates of amputation and fewer revascularization procedures compared to non-Hispanic white adults with PAD. The prevalence of PAD among Hispanic individuals has been difficult to determine because this population often experiences a lack of access to health care and is underrepresented in many population-based studies. Our study raises awareness and confirms some of these disparities."
Kristie Harris, Ph.D., lead study author, instructor of medicine, Yale School of Medicine, New Haven, Connecticut
Harris and her team examined hospital admission data from the 2011-2017 National Inpatient Sample to study differences in the experiences of Hispanic and non-Hispanic white adults treated for PAD symptoms. They investigated whether people sought inpatient PAD care by presenting to the ER or if they came for a planned, elective visit, likely sent by an outpatient care professional.
During the study period, there were 1,018,220 PAD hospitalizations among adults age of 18 years and older in the U.S. (39% female; 14% Hispanic adults).
The percentage of people who accessed inpatient hospital care via the emergency department increased among both Hispanic adults and non-Hispanic white adults between 2011-2017. The increase was substantial among those who are Hispanic, with the percentage of PAD hospital admissions occurring through the ER jumping from 50% to 70% over the course of the study period.
The researchers found that Hispanic adults with PAD were 80% more likely to access inpatient PAD care by going to the emergency room for symptoms compared with non-Hispanic white adults hospitalized with PAD. Additionally, Hispanic adults were 12% less likely to undergo elective hospital admissions for PAD.
Among the other findings in the study:
- Across all years, 58% of hospital admissions among Hispanic adults began with a visit to the emergency room, compared with 36.7% for non-Hispanic white adults.
- The average hospital visit was 4.5 days for Hispanic patients versus 3.7 days for non-Hispanic white patients, and overall hospital costs were higher, too – $63,813 versus $52,368, respectively.
"Our findings reinforce other research that indicates Hispanic individuals often lack a usual source for routine health care and frequently defer or avoid care due to costs," Harris said. "Instead of delaying care, a better way to manage PAD and reduce the risks of future complications is with regular evaluation and follow-up, usually with a primary care doctor or vascular specialist."
Harris said prevention is key, and as with any other type of cardiovascular disease, people should be encouraged to quit smoking, be physically active and to manage diabetes, high blood pressure or high cholesterol, which all increase the risk for PAD. Individuals who develop pain in their feet or legs with walking not associated with muscle strain should seek medical care early for a comprehensive evaluation.
"This study highlights the importance of better tailoring PAD prevention and management, especially among Hispanic people, which could reduce the need for hospital emergency room care or hospitalization," she said. "Systematic efforts are needed to ensure Hispanic people with PAD have more accessible, affordable and culturally sensitive outpatient care. Efforts should include supports that educate the community regarding the signs and symptoms of PAD and encouragement to seek care early."