The Time Is Now

 

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The time is now for you to focus your practice on peripheral arterial disease (PAD). There are several reasons for this which will be discussed in the article. Lower extremity PAD is defined as atherosclerotic disease affecting the lower extremity arteries. Worldwide, it is estimated that there are more than 230 million patients with PAD. There are approximately 8 to 12 million patients in the United States with PAD.[1] Patients older than 65 years are at risk for developing PAD.[2] It is estimated by 2050 that 19 million people will have PAD.

Despite 50 years of treating PAD using endovascular techniques, there continues to be disparities in the treatment and detection for PAD.[2] This is highlighted by data showing differences in utilization rates of technologies to treat patients with PAD and differences in amputation rates throughout the country.[3] Blacks and Hispanics are disproportionately affected.[2] These disparities continue to be highlighted by the lack of awareness of PAD symptoms by patients, detection and treatment by health care practitioners, and lack of research and advocacy for patients with PAD.[4] [5]

The end product of PAD is critical limb-threatening ischemia and it costs our health care system on average 80,000 USD per year to treat this particular condition once it develops.[6] The 1-year mortality is 30%, which is higher than that of symptomatic coronary artery disease. When compared to different cancers for mortality outcomes, PAD would rank third.[6] There is a global pandemic of PAD which is occurring, and patients are suffering.

Recently, the American Heart Association with partnering professional organizations, including the Society of Interventional Radiology, put forth a PAD national action plan.[7] The plan was developed with input from multiple different specialists and has six different goals which will be discussed briefly. These goals include public awareness, professional education, detection and treatment, intervention, research, and advocacy.

Studies have demonstrated that there is decreased awareness of PAD symptoms by patients.[8] The first goal is to increase public awareness for PAD by the patients themselves. This will be achieved by reaching people who are at risk for developing PAD and educating them about different PAD symptoms. This particular goal has several different action items including the establishment of a diverse national patient advisory group to help identify information that needs to be communicated to address public awareness gaps and how best to communicate it. Another goal is to develop communication and messaging that will help increase PAD awareness to diverse audiences. This will prioritize an approach to reach at-risk groups and identify partners to amplify consumer awareness initiatives.

The lack of awareness of PAD is also seen within health care providers.[6] The second goal is aimed at improving PAD awareness for the signs and symptoms among health care providers. This can be improved through professional education that will need to be enhanced for people who care for patient with PAD. Goals to improve awareness in health care professionals include teaching professionals how to empower patients with PAD to make and sustain self-care strategies. In addition, educational modules and opportunities will need to be created for multidisciplinary health care professionals. Central to this is increased screening and detection of patients at risk for PAD through provider education. Finally, education focused on appropriate, guideline-directed medical therapy will need to be enhanced.

PAD detection and treatment is goal three. This goal will “activate health care systems to provide enhanced programs for the detection and treatment of PAD patients, with a focus on understanding and addressing patient-centered outcomes.” There are three major areas of focus including improved PAD detection, treatment, and timely referral for revascularization through health system activation. The other goal is to help establish standards and accreditation for supervised exercise therapy programs that can provide approaches for patient-centered PAD care.

Goal four is PAD interventions. The major emphasis of this goal is to help reduce the rates of nontraumatic lower extremity amputations related to PAD through public outcome reporting and public health interventions.[9] It is important to help establish public reporting of amputations by hospitals. To accomplish this, there will need to be a public policy for an acceptable payment and service delivery model to improve PAD care and focus on at-risk populations.

The fifth goal is PAD research. The intent of this goal is to increase basic and translational research in PAD. There needs to be an increase in research training and career development in PAD. In addition, there needs to be comparative effectiveness research in PAD and critical limb ischemia.

The final goal is aimed at improving PAD advocacy. At a national level, this will help coordinate and develop national policies for improving health outcomes for PAD patients. Easily accessible resources and guides must be made available to train advocacy volunteers through the creation of a PAD advocacy toolkit. A major effort through a multispecialty approach will be needed to help influence policymakers in support of a comprehensive PAD national action agenda.

Publication History

Article published online:
16 June 2023

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• References

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