PAD National Action Plan


The PAD National Action Plan is comprised of six main goals:


1 Reach people with PAD and those at risk for PAD


by improving public awareness of PAD symptoms and diagnosis.


2 Enhance professional education for


multidisciplinary healthcare professionals who care for people with PAD.


3 Activate healthcare systems to provide


enhanced programs for the detection and treatment of PAD patients, with a focus on understanding and addressing patient-centered outcomes.


4 Reduce the rates of nontraumatic lower


extremity amputations related to PAD through public outcome reporting and public health interventions.


5 Increase and sustain research to better


understand prevention, diagnosis and treatment of PAD.


6 Coordinate PAD advocacy efforts to shape


national policy and improve health outcomes.


The U.S. Preventive Services Task Force (USPSTF) recommendations say there is insufficient evidence to screen for PAD in asymptomatic patients. But what is considered a symptom? That’s the question Yolanda Bryce, MD, an IR at Memorial Sloan Kettering Cancer Center, wants more people to consider and to research.


“What people normally equate to a symptom is what we call claudication— which is pain with walking in the buttocks, hips or legs that goes away with rest—but a lot of people don’t present with those exact symptoms,” Dr. Bryce said. “For example, women disproportionately present with atypical exertional leg pain that starts at rest or keeps going even after rest. That might not be considered a PAD symptom, so you may not screen for PAD even though you should.”


In addition, Dr. Bryce said, Black patients disproportionately present with decreased activity, not pain. “So, if you don’t screen for that, which you’re likely not going to do, you will miss that person and then they’ll later present with advanced disease.”


Even with claudication, patients and healthcare providers might assume other causes such as arthritis or a muscle injury, not understanding the severity, said Sanjay Misra, MD, FAHA, FSIR, who represented SIR in the group that developed the national plan.


“A lot of patients go to these different providers first—nephrologist, diabetologist, endocrinologist, podiatrist—so raising awareness of guidelines is important,” Dr. Misra said. “Guidelines are meant to help physician providers, but you actually need to suspect PAD before the guidelines can even help you.”


Patients with coronary artery disease (CAD) are also at risk for PAD, since the same problems are at play. And yet, according to the AHA, even patients with clinically diagnosed PAD are not treated as frequently with guideline- directed medical therapy, such as statins or antiplatelet agents, as those with clinically diagnosed CAD are.


Limb amputations increase in United States A critical concern is that lack of screening, diagnosis and treatment


Glossary


Equity: Providing fair treatment, access, resources and opportunities while acknowledging specific barriers and needs. Unlike equality, which provides all individuals with identical resources and opportunities, equity acknowledges systemic biases and allocates resources to allow all individuals to reach an equal outcome.


20 IRQ | WINTER 2023


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