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Eliminating Disparities in PAD Requires Interventions in Education, Access and Health Policy

Disparities by sex, race, socioeconomic status and geography exist in the diagnosis, treatment and outcomes for patients with lower extremity peripheral artery disease (PAD), and eliminating these inequities will require improvements in education, access to care and health policy, according to a JACC Scientific Statement published Dec. 4.

In their statement, Mary M. McDermott, MD, et al., provide an overview of PAD epidemiology, disparities and guideline-recommended therapy; explore the differences in PAD among patients of varying demographics; and propose potential solutions.

The authors note that women with PAD who present for revascularization are typically older by about 3.5 years than men and they are also "more likely to undergo revascularization for chronic limb-threatening ischemia than for intermittent claudication symptoms." The authors also emphasize that Black people have an approximately twofold higher prevalence of PAD and have more atypical symptoms, greater mobility loss and less optimal medical care than White patients. In addition, PAD amputations are more common among Black and Hispanic patients than in White patients. Poor outcomes vary by geographic region as well, with the highest rates of amputation in the U.S. occurring in the Southeast.

The authors discuss several strategies to overcome PAD disparities, including approaches incorporating patient education around risk for PAD; increasing knowledge about PAD among patients, the public and clinicians; improving early detection and treatment of PAD through increased access to care, and more.

They propose six specific initiatives, including: creation of a "heat" map to illustrate communities with high instances of PAD and PAD-related amputations; routinely asking all patient 50 years and older about walking ability; public education about PAD symptoms, specifically leg discomfort, weakness and declining ability to walk; individuals with histories of heart disease, stroke, diabetes or tobacco use undergoing ankle-brachial index testing; ensuring supervised exercise and effective home-based exercise programs are widely available; and increasing diversity of sex, socioeconomic status and race in randomized clinical trials.

"Disparities in the diagnosis and treatment of patients with PAD are likely to contribute to higher rates of adverse outcomes, including cardiovascular events, [major adverse limb events], mobility impairment and amputation," write the authors. "…Future work should focus on developing intentional interventions directed toward clinicians, scientists, patients, the health care system and health policy to eliminate disparities in PAD."

Clinical Topics: Cardiovascular Care Team, Prevention, Vascular Medicine, Atherosclerotic Disease (CAD/PAD), Exercise

Keywords: Intermittent Claudication, Ankle Brachial Index, Peripheral Arterial Disease, Lower Extremity, Exercise Therapy, Health Policy, Stroke, Tobacco Use, Diabetes Mellitus, Treatment Outcome, Health Services Accessibility, Heart Diseases, Randomized Controlled Trials as Topic, Patient Education as Topic

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