Evidence mapPaperPMID 39749477Full record

Observational studyCirculation. Cardiovascular quality and outcomes2025

Racial, Socioeconomic, and Geographic Disparities in Preamputation Vascular Care for Patients With Chronic Limb-Threatening Ischemia.

Omar I Ramadan, Lin Yang, Kaitlyn Shultz, Elizabeth Genovese, Scott M Damrauer, Grace J Wang, Eric A Secemsky, Diane J Treat-Jacobson, Robin J Womeodu, Foluso A Fakorede and 7 more

Abstract readComparative StudyObservational Study
In one paragraph

Observational study in Circulation. Cardiovascular quality and outcomes, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers.

0numbers the graph read from it
0cells of the map it votes in
6citing papers in PubMed
field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

6 citing papers in PubMed.

  1. Article
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  3. Review
  4. Article
  5. Review
  6. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

17 authors.

Omar I RamadanDivision of Vascular Surgery and Endovascular Therapy (O.I.R., E.G., S.M.D., G.J.W.), Perelman School of Medicine, University of Pennsylvania, Philadelphia.ORCID 0000-0003-0194-2860
Lin YangPenn Cardiovascular Outcomes, Quality, and Evaluative Research Center (L.Y., K.S., E.G., S.M.D., G.J.W., A.S.N., L.A.E., H.M.J., T.J.K., P.W.G., J.G., A.C.F.), Perelman School of Medicine, University of Pennsylvania, Philadelphia.ORCID 0000-0001-9267-6531
Kaitlyn ShultzPenn Cardiovascular Outcomes, Quality, and Evaluative Research Center (L.Y., K.S., E.G., S.M.D., G.J.W., A.S.N., L.A.E., H.M.J., T.J.K., P.W.G., J.G., A.C.F.), Perelman School of Medicine, University of Pennsylvania, Philadelphia.
Elizabeth GenoveseDivision of Vascular Surgery and Endovascular Therapy (O.I.R., E.G., S.M.D., G.J.W.), Perelman School of Medicine, University of Pennsylvania, Philadelphia.ORCID 0000-0002-9931-9999
Scott M DamrauerDivision of Vascular Surgery and Endovascular Therapy (O.I.R., E.G., S.M.D., G.J.W.), Perelman School of Medicine, University of Pennsylvania, Philadelphia.ORCID 0000-0001-8009-1632
Grace J WangDivision of Vascular Surgery and Endovascular Therapy (O.I.R., E.G., S.M.D., G.J.W.), Perelman School of Medicine, University of Pennsylvania, Philadelphia.ORCID 0000-0003-3241-9669
Eric A SecemskySmith Center for Cardiovascular Outcomes Research, Beth Israel Deaconess Medical Center, Harvard Medical School, Harvard University, Boston, MA (E.A.S.).ORCID 0000-0003-3861-3163
Diane J Treat-JacobsonSchool of Nursing, University of Minnesota, Minneapolis (D.J.T.-J.).ORCID 0000-0003-3296-8764
Robin J WomeoduMethodist Le Bonheur Healthcare, Memphis, TN (R.J.W.).ORCID 0009-0008-8455-7231
Foluso A FakoredeCardiovascular Solutions of Central Mississippi, Cleveland (F.A.F.).ORCID 0000-0001-5286-9566
Ashwin S NathanPenn Cardiovascular Outcomes, Quality, and Evaluative Research Center (L.Y., K.S., E.G., S.M.D., G.J.W., A.S.N., L.A.E., H.M.J., T.J.K., P.W.G., J.G., A.C.F.), Perelman School of Medicine, University of Pennsylvania, Philadelphia.ORCID 0000-0002-7227-6423
Lauren A EberlyPenn Cardiovascular Outcomes, Quality, and Evaluative Research Center (L.Y., K.S., E.G., S.M.D., G.J.W., A.S.N., L.A.E., H.M.J., T.J.K., P.W.G., J.G., A.C.F.), Perelman School of Medicine, University of Pennsylvania, Philadelphia.ORCID 0000-0003-0879-7694
Howard M JulienPenn Cardiovascular Outcomes, Quality, and Evaluative Research Center (L.Y., K.S., E.G., S.M.D., G.J.W., A.S.N., L.A.E., H.M.J., T.J.K., P.W.G., J.G., A.C.F.), Perelman School of Medicine, University of Pennsylvania, Philadelphia.ORCID 0000-0002-4130-097X
Taisei J KobayashiPenn Cardiovascular Outcomes, Quality, and Evaluative Research Center (L.Y., K.S., E.G., S.M.D., G.J.W., A.S.N., L.A.E., H.M.J., T.J.K., P.W.G., J.G., A.C.F.), Perelman School of Medicine, University of Pennsylvania, Philadelphia.ORCID 0000-0002-3081-6225
Peter W GroeneveldPenn Cardiovascular Outcomes, Quality, and Evaluative Research Center (L.Y., K.S., E.G., S.M.D., G.J.W., A.S.N., L.A.E., H.M.J., T.J.K., P.W.G., J.G., A.C.F.), Perelman School of Medicine, University of Pennsylvania, Philadelphia.ORCID 0000-0002-7374-4292
Jay GiriPenn Cardiovascular Outcomes, Quality, and Evaluative Research Center (L.Y., K.S., E.G., S.M.D., G.J.W., A.S.N., L.A.E., H.M.J., T.J.K., P.W.G., J.G., A.C.F.), Perelman School of Medicine, University of Pennsylvania, Philadelphia.ORCID 0000-0002-8076-0098
Alexander C FanaroffPenn Cardiovascular Outcomes, Quality, and Evaluative Research Center (L.Y., K.S., E.G., S.M.D., G.J.W., A.S.N., L.A.E., H.M.J., T.J.K., P.W.G., J.G., A.C.F.), Perelman School of Medicine, University of Pennsylvania, Philadelphia.ORCID 0000-0002-9060-5307

Funding

Improving the Quality of Heart Failure Care for American Indian Patients Receiving Care through the Indian Health ServiceK23HL166974 · UNIVERSITY OF PENNSYLVANIA · 2025 to 2025
$189k
NHLBI NIH HHS K23 HL166974
6 · The paper itself

Abstract

backgroundBlack patients, those with low socioeconomic status (SES), and those living in rural areas have elevated rates of major lower extremity amputation, which may be related to a lack of subspecialty chronic limb-threatening ischemia care. We evaluated the association between race, rurality, SES, and preamputation vascular care.

methodsAmong patients aged 66 to 86 years with fee-for-service Medicare who underwent major lower extremity amputation for chronic limb-threatening ischemia from July 2010 to December 2019, we compared the proportion who received vascular care in the 12 months before amputation by race (Black versus White), rurality, and SES (dual eligibility for Medicaid versus no dual eligibility) using multivariable logistic regression adjusting for clinical and demographic covariates.

resultsAmong 73 237 patients who underwent major lower extremity amputation, 40 320 (55.1%) had an outpatient vascular subspecialist visit, 60 109 (82.1%) had lower extremity arterial testing, and 28 345 (38.7%) underwent lower extremity revascularization in the year before amputation. Black patients were less likely to have an outpatient vascular specialist visit (adjusted odds ratio [adjOR], 0.87 [95% CI, 0.84-0.90]) or revascularization (adjOR, 0.90 [95% CI, 0.86-0.93]) than White patients. Compared with patients without low SES or residing in urban areas, patients with low SES or residing in rural areas were less likely to have an outpatient vascular specialist visit (adjOR, 0.62 [95% CI, 0.60-0.64]; low SES versus nonlow SES; adjOR, 0.82 [95% CI, 0.79-0.85]; rural versus urban), lower extremity arterial testing (adjOR, 0.78 [95% CI, 0.75-0.81]; low SES versus nonlow SES; adjOR, 0.90 [95% CI, 0.0.86-0.94]; rural versus urban), or revascularization (adjOR, 0.65 [95% CI, 0.63-0.67]; low SES versus nonlow SES; adjOR, 0.89 [95% CI, 0.86-0.93]; rural versus urban).

conclusionsBlack race, rural residence, and low SES are associated with failure to receive subspecialty chronic limb-threatening ischemia care before amputation. To reduce disparities in amputation, multilevel interventions to facilitate equitable chronic limb-threatening ischemia care are needed.

Indexed as

Amputation, SurgicalBlack or African AmericanChronic Limb-Threatening IschemiaHealthcare DisparitiesHealth Services AccessibilityIschemiaLower ExtremityPeripheral Arterial DiseaseSocial Determinants of HealthSocioeconomic FactorsWhiteAgedAged, 80 and overChronic DiseaseFemaleHumansamputation, surgicalchronic limb-threatening ischemiahealthcare disparitieshealth services accessibilityperipheral arterial disease

Identifiers

PMID39749477
PMCPMC11745589

What Socratic holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.