Effective management of PAD may cut lower-extremity amputations by 20% by 2030: AHA
To combat recent increases in rates of nontraumatic lower-extremity amputations in the U.S., most of which occur in patients with diabetes, the American Heart Association (AHA) has recently recommended enhanced public awareness of peripheral artery disease (PAD) as well as policies to improve diagnosis and optimal care.
In a policy statement published March 25 by Circulation, the AHA noted that nontraumatic leg amputations in patients with diabetes decreased by approximately 40% from 2000 to 2009 but increased by 50% from 2009 to 2015. To stop and reverse these trends, actionable policies to reduce the incidence of critical limb ischemia (CLI) and improve care are needed, the statement said. This statement describes the impact of amputation on patients and society, summarizes medical approaches to identify PAD and prevent its progression, and proposes policy solutions to prevent limb amputation.
The statement recommends improving public awareness of PAD and greater use of effective PAD management strategies, such as smoking cessation, statins, and foot monitoring/care in patients with diabetes. It also proposes regulatory/legislative and organizational/institutional policies, such as adoption of quality measures for PAD care; affordable prevention, diagnosis, and management; regulation of tobacco products; clinical decision support for PAD care; professional education; and dedicated funding opportunities to support PAD research. The statement noted that since some racial and ethnic groups and patients who live in poverty are at higher risk for PAD but often have less access to high-quality vascular care, improved PAD diagnosis and management could greatly affect health care disparities.
The key highlights of the statement has been summerised below.
- Performance measures should address the following in patients with PAD: Statins Smoking cessation Glucose control if diabetes is present Annual foot monitoring if diabetes is present.
- Government reports should acknowledge PAD as an important phenotype of cardiovascular disease.
- Medical care must be affordable, accessible, and equitable for patients with PAD.
- Appropriate pharmacological therapy should be available with minimal copay to patients with PAD
- Tobacco cessation therapy should be comprehensive and available in all public and private health care plans at no copay.
- Comprehensive diabetes management, including pharmacotherapies and foot monitoring, should be affordable and accessible.
- Funding agencies should have dedicated grant opportunities to support PAD research.
- Health care systems should integrate clinical decision support for PAD.
"There is considerable opportunity to improve the care of patients with PAD and thereby reduce the risk of CLI, foot ulceration, and limb amputation. Thus, it is time to take action," the statement authors wrote. "We urge that policymakers ranging from regulatory bodies to health systems and individual institutions refer to this policy statement and implement its recommendations to achieve the goal of reducing the rate of nontraumatic lower-extremity amputations by 20% by 2030."
For full article follow the link: https://doi.org/10.1161/CIR.0000000000000967
PRIMARY SOURCE: Circulation
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