VESS01 - Female patients with vascular disease receive less medical optimization despite more healthcare utilization

Objectives: Despite optimal medical therapy (OMT) being a cornerstone of vascular care, female patients are less likely to be medically optimized in comparison to their male counterparts. We aimed to quantify preoperative access to medical care and hypothesized that women will have a lower rate of OMT while controlling for healthcare utilization.

Methods: This was a retrospective cohort study at an 18-hospital, unified health care system. We included all adults undergoing index, elective, operative interventions for carotid, aortic, or lower extremity disease (2016-2024). The primary outcome was receipt of OMT (statin, antiplatelet or anticoagulation, smoking cessation). Multivariable logistic regression evaluated the association between OMT and sex at birth while controlling for comorbid conditions, healthcare utilization (1-year preoperative, outpatient primary care provider [PCP] or cardiology visits), and interventions generating adjusted odds ratios (aOR) with 95% confidence intervals (CI).

Results: Among 18,719 patients, 8,140 (43.5%) were female. Females were younger with more comorbid conditions and current tobacco usage than males (Table). Females more frequently saw their PCP preoperatively (42.0% vs. 40.5%; p=0.042) and had more visits (3.3±7.4 vs. 2.9±7.0; p< 0.001). Females less frequently saw a preoperative cardiologist (28.9% v. 38.7%; p< 0.001). Despite increased PCP exposure, females were less frequently prescribed a statin, an antiplatelet agent, or an anticoagulant. They were more frequently prescribed pain medications. As such, females less frequently received OMT (25.6% vs. 32.3%; p< 0.001). On multivariable modeling (Figure), female sex had lower odds of preoperative OMT (aOR 0.83, 95%CI [0.75-0.90], p< 0.001). While seeing a PCP (aOR 1.81, 95%CI [1.67-1.97], p< 0.001) and cardiologist (aOR 1.90, 95%CI [1.74-2.07], p< 0.001) were both associated with an increased rate of OMT, these associations were not moderated by sex (p-interaction>0.05) indicating the association between female sex and lower OMT receipt was not altered by these providers evaluations.

Conclusions: The prevalence of vascular disease is equitable between the sexes – a fact commonly unrecognized by the healthcare community. Consequently, female patients are less likely to receive OMT for vascular disease despite increased healthcare access in the form of PCP visits. Our study recapitulates provider biases leading to an undertreatment of OMT for females with vascular disease and such awareness is required to enact change and improve outcomes.