Contact: Amanda Jekowsky, email@example.com, 202-375-6645
Despite the overwhelming evidence that patients with peripheral artery disease (PAD) – a narrowing or blockage of the arteries in the abdomen and legs – have a reduced quality of life because of the inability to walk without pain (claudication) and have an increased risk of heart attack, stroke and death, these patients are often underdiagnosed and undertreated.
In an effort to systematically improve the diagnosis and treatment of PAD and, in turn, help prevent cardiac events and premature death, the American College of Cardiology/American Heart Association Task Force on Performance Measures today issued the first-ever performance measures for adults with PAD. These new performance measures also aim to increase understanding of the serious heart-related effects of PAD within the health care community at large and to facilitate reimbursement of evidence-based practices.
“Patients with peripheral artery disease have the highest rate of heart attacks, stroke and cardiovascular death—higher than people with coronary artery disease—yet they remain undertreated,” said Jeffrey W. Olin, D.O., FACC, FAHA, Professor of Medicine, Mount Sinai School of Medicine and chair of the writing committee. “Therapies simply aren’t given with the same intensity. These patients receive antiplatelet therapy (aspirin or clopidogrel) or statin therapy (cholesterol-lowering medications) much less frequently than patients with coronary artery disease despite their high cardiovascular event rate.”
Studies have found that people with PAD are up to six times more likely to die of heart disease compared to age-matched controls. Moreover, pooled results of eight randomized prospective trials show patients with PAD and coronary disease are more than twice as likely to die one year after undergoing percutaneous coronary intervention than patients with coronary disease alone.
“Even when PAD is diagnosed, many healthcare providers will often just treat the leg symptoms, for example, any leg pain, tightness or cramping the patient might report, and not the heart-related risks,” said Dr. Olin. “Once PAD is diagnosed, appropriate therapy can be instituted to improve the ability to walk further and faster without pain, and lower the rate of heart attack, stroke and death from cardiovascular causes.”
The new performance measures are intended to help ensure earlier diagnosis and more appropriate modification of cardiovascular risk factors among patients with PAD.
The set of performance measures includes the use of:
- Ankle brachial index (ABI) in patients deemed at risk – an easy and inexpensive way to screen for PAD by measuring the blood pressure in the ankle and the arm
- Statin therapy to lower the LDL cholesterol to less than 100 mg/dL
- Smoking cessation interventions to help active smokers stop
- Antiplatelet therapy with aspirin or clopidogrel to reduce risk of heart attack, stroke or death in people with history of symptomatic PAD
- Supervised exercise programs – similar to cardiac rehabilitation for patients who have had a heart attack or coronary bypass surgery; increases walking distance and is good for general heart health
- Lower extremity vein bypass graft surveillance – periodic ankle brachial index and ultrasound to make sure a bypass in the legs is continuing to function well
- Monitoring of abdominal aortic aneurysms(when the aorta, the main blood vessel in the abdomen, becomes abnormally large or balloons outward)
Olin and members of the Task Force expect that these performance measures, once incorporated into routine practice, will improve patients’ overall well-being, quality of life and pain-free walking distance and speed, as well as reduce heart attack, stroke and death. As more clinicians adopt these practices more widely, the hope is that reimbursement of ABI and supervised exercise programs—two measures not currently reimbursed—will follow.
“The most effective therapy for PAD—a supervised exercise program—is not reimbursed by most third party payers, even though virtually every randomized trial has shown that when used for patients with claudication, they are able to increase their walking distance by up to 200 percent and their walking speed also increases,” explained Dr. Olin. “This is more than can be achieved with any medication that is available on the market.”
The selection of performance measures was based on a thorough evaluation of the evidence base for a given measure, the ease and/or complexity of measurement, and whether the measurement was covered in previously published measurement sets. The writing committee included experienced clinicians and specialists in vascular medicine, cardiology, vascular surgery, exercise physiology, vascular and interventional radiology, interventional cardiology, endocrinology and epidemiology.
The performance measures will be published in the December 14/21, 2010, issue of the Journal of the American College of Cardiology (JACC) and co-published in the December 14, 2010, issue of Circulation: Journal of the American Heart Association, the Journal of Vascular Nursing, the Journal of Vascular Surgery, and the Vascular Medicine Journal. It is also available at www.cardiosource.org and www.heart.org.
PAD is estimated to affect nearly one-third of people over the age of 70 years or those 50 to 69 years of age who have a history of diabetes or ever smoking. The clinical presentation of PAD may vary from no symptoms (in up to half of patients) to intermittent claudication (cramping pain that limits the ability to walk), atypical leg pain, rest pain, ischemic ulcers, or gangrene.
About the Writing Committee and Collaborating Organizations
In addition to ACC and AHA, writing committee member organizations include the American College of Radiology, the Society for Cardiac Angiography and Interventions, the Society for Interventional Radiology, the Society for Vascular Medicine, the Society for Vascular Nursing, and the Society for Vascular Surgery. The new PAD performance measures were also developed in collaboration with the American Association of Cardiovascular and Pulmonary Rehabilitation, the American Diabetes Association, the Society for Atherosclerosis Imaging and Prevention, the Society for Cardiovascular Magnetic Resonance, the Society of Cardiovascular Computed Tomography, and the PAD Coalition. The report is also endorsed by the American Academy of Podiatric Practice Management.
Dr. Olin has consulted for Genzyme, Merck and Sanofi/BMS partnership.
The American College of Cardiology is transforming cardiovascular care and improving heart health through continuous quality improvement, patient-centered care, payment innovation and professionalism. The College is a 39,000-member nonprofit medical society comprised of physicians, surgeons, nurses, physician assistants, pharmacists and practice managers, and bestows credentials upon cardiovascular specialists who meet its stringent qualifications. The College is a leader in the formulation of health policy, standards and guidelines, and is a staunch supporter of cardiovascular research. The ACC provides professional education and operates national registries for the measurement and improvement of quality care. More information about the association is available online at http://www.cardiosource.org/ACC.
The American Heart Association, founded in 1924, is the nation’s oldest and largest voluntary health organization dedicated to building healthier lives, free of heart disease and stroke. To help prevent, treat and defeat these diseases — America’s No. 1 and No. 3 killers — we fund cutting-edge research, conduct lifesaving public and professional educational programs, and advocate to protect public health. To learn more or join us in helping all Americans, call 1-800-AHA-USA1 or visit www.heart.org.