Female patients with vascular disease had lower odds of receiving documented preoperative optimal medical therapy compared to males (aOR 0.80; 95% CI 0.75-0.6; P<.001), despite more primary care visits.
Cohort (n=18,673)
Yes
Are female patients with vascular disease less likely to receive documented optimal medical therapy compared to males?
Female patients with vascular disease are significantly less likely to receive optimal medical therapy prior to intervention compared to males, despite having more primary care visits.
Effect estimate: aOR 0.80 (95% CI 0.75-0.6)
Absolute Event Rate: 23% vs 28.2%
p-value: p=<.001
OBJECTIVE: Despite optimal medical therapy (OMT) being a cornerstone of vascular care, female patients are less likely to receive it in comparison with males. This study aimed to quantify preoperative access to care and hypothesized that women would have lower documented OMT prescription rates while controlling for health care use. METHODS: This retrospective cohort study used a single-center, multihospital dataset of all adults undergoing index, elective, operative interventions for carotid, aortic, or lower extremity disease (2016-2024). The primary outcome was documented OMT (statin, antiplatelet, and nonsmoking). Multivariable logistic regression evaluated the association between documented OMT and sex, adjusting for comorbidities and health care use. RESULTS: Among 18,673 patients, 8135 (43.6%) were female. Females more frequently saw a primary care physician (PCP) (42.0% vs 40.5%; P = .042) with more visits on average (3.3 ± 7.4 vs 2.9 ± 7.0; P < .001). Females were less likely to see a cardiologist (28.9% vs 38.7%; P < .001). Despite increased PCP exposure, females were less frequently prescribed OMT (23.0% vs 28.2%; P < .001). They were more frequently prescribed pain medications (50.5% vs 42.9%; P < .001). On multivariable modeling, female sex had lower odds of preoperative OMT (adjusted odds ratio aOR, 0.80; 95% confidence interval CI, 0.75-0.6; P < .001). A PCP visit (aOR, 1.63; 95% CI, 1.52-1.75; P < .001) or cardiology visit (aOR, 1.73; 95% CI, 1.60-1.87; P < .001) were both associated with an increased rate of achieving documented OMT. CONCLUSIONS: Female patients were less likely to have documented OMT despite increased health care access in the form of PCP visits. Our findings highlight a potential provider bias leading to an undertreatment of females with vascular disease.
Lowenkamp et al. (Thu,) conducted a cohort in Vascular disease (carotid, aortic, or lower extremity disease) (n=18,673). Female sex vs. Male sex was evaluated on Documented optimal medical therapy (statin, antiplatelet, and nonsmoking) (aOR 0.80, 95% CI 0.75-0.6, p=<.001). Female patients with vascular disease had lower odds of receiving documented preoperative optimal medical therapy compared to males (aOR 0.80; 95% CI 0.75-0.6; P<.001), despite more primary care visits.