VESS08 - National Vascular Quality Initiative data finds disparities in aortic aneurysm care in rural patients

Objectives: The presentation and outcomes of aortic aneurysms in rural populations have not been well described. Rural patients often face significant geographic and socioeconomic barriers to accessing care and as such, may be more likely to present with larger aneurysms, require more urgent repair, and be more likely to be lost to follow-up (LTFU). The purpose of this study was to assess the impact of rural residence on the presentation of aortic aneurysms and the likelihood of being LTFU after endovascular repair.

Methods: The VQI EVAR (2003-2021) and TEVAR/Complex EVAR modules (2010-2021) comprised the sample. We excluded procedures for non-aneurysmal disease. Patients were categorized as urban or rural based on Rural-Urban Commuting Area (RUCA) codes. Univariate analyses were used to describe differences in sociodemographic, intraoperative, and LTFU factors. Unadjusted and adjusted binomial Generalized Estimating Equations (GEE) models clustered at the physician level were fit to assess the association between rurality of the patient’s residence with large aneurysm size (defined as >6 cm (males) and >5.5 cm (females) for abdominal aortic aneurysm (AAA), and >6.5 cm (males) and >6 cm (females) for thoracic aortic aneurysm (TAA)/complex AAA), symptomatic presentation, major adverse cardiovascular events (MACE) or death, type of follow-up, and being LTFU.

Results: 72,587 patients were included in the analysis. 79% (n=57,801) of patients were urban and 21% (n=15,056) were rural. Most demographic variables were significantly different between the two groups (Table I). In the adjusted models, compared to residing in an urban area, residing in a rural area was significantly associated with 9% higher odds of large aneurysm diameter (p < 0.001) at time of presentation, 20% higher odds of having an urgent/emergent presentation (p < 0.001), 9% lower odds of having any follow-up imaging (p=0.012), 13% lower odds of having in-person follow-up (p < 0.001), and 11% higher odds of being LTFU (p=0.012) (Table II). Rural residence was not associated with increased odds of MACE or death.

Conclusions: Our findings indicate that rural patients have higher odds of presenting with large aneurysms, and are more likely to be LTFU, or have inadequate follow-up (i.e.: without appropriate imaging). These results highlight the importance of aneurysm screening in rural populations and improved access to vascular care for these patients. Additionally, resources focused on empowering community providers to assist with appropriate follow-up may be warranted in rural communities. This is key to avoiding disparities in aneurysm outcomes in the future.