Evidence about sex differences in outcomes and management of critical limb ischemia (CLI) is contradictory. Fee-For-Service Medicare patients were identified within the 5% enhanced sample file diagnosed with new incident CLI between the years 2015-2017. For each beneficiary, all pharmacy prescriptions, outpatient procedures and encounters, and hospital admissions were identified.
The incidence of CLI declined from 2.80 to 2.47 per 1000 people from 2015 to 2017. Incidence was lower in women than men (2.19 vs. 3.11 per 1000) however receeded in both groups. Women had a lower prevalence of prescription of any statin (48.4% vs. 52.9%) or high-intensity statins (15.3% vs. 19.8%) compared with men. Women had an unadjusted (9.9% vs. 10.3%) and adjusted 90-day mortality compared with men. Men had higher unadjusted (12.9% vs. 8.9%) and adjusted risk of 90-day major amputation.
In conclusion, CLI is associated with significant morbidity and mortality in both sexes. The incidence of CLI is higher than what was reported in the past, and the majority of patients are managed on an outpatient basis. The use of evidence-based guideline-directed therapy, such as statins and revascularization in patients with CLI, remains suboptimal, and although we found a lower probability of these therapies in women, the differences were small.