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Peripheral arterial disease poses significant public health challenges, particularly among minority and the socioeconomically disadvantaged patients. This study scrutinized trends in femoropopliteal revascularization procedures and outcomes amidst clinical practice changes catalyzed by the paclitaxel-coated device controversy, the COVID-19 pandemic, and the BEST-CLI trial results. Leveraging Medicare/Medicaid administrative claims from 2016 to 2023, linked with the Distressed Communities Index and the Rural-Urban Continuum Codes, we examined revascularization trends and their outcomes across geographic regions, procedural locations, and different sociodemographic groups. The primary outcome was amputation-free survival, and secondary outcomes included major amputation and survival. Multivariate Cox analysis was used to estimate cumulative incidences and regression analyses to study temporal trends. Of 1,040,000 procedures performed during the study period, there were notable practice changes. Following the paclitaxel meta-analysis publication, there was a sharp decline in drug-coated balloon use, counterbalanced by an increase in non-drug coated balloon angioplasty (Figure). During the COVID-19 pandemic, revascularizations in Black patients dropped from 16.7% to 13.8%, and patients in distressed communities saw in a decrease from 27.0% to 22.10% of revascularizations. Outcomes results will be shared during the full presentation. This study offers evidence of large-scale practice changes in vascular care leading to disproportionate impact among vulnerable populations.
Kim et al. (Wed,) studied this question.