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Preventing amputations and saving lives starts with bringing PAD into the 21st century

There’s a condition that is crippling Black and brown communities at a disproportionate rate and causing 400 amputations each day in the U.S. That may sound scary, but the most frightening part? A new consumer survey found that 70 percent of Americans have never heard of the most common vascular disease, peripheral artery disease (PAD) – PAD kills more people than three of the top cancers (breast cancer, colorectal cancer, and prostate cancer) combined and is the leading cause of non-trauma amputations. To say we are experiencing an amputation epidemic in this country would not be an overstatement – it’s a reality for far too many people, and we can work together as a clinical community to stop it.

The prevalence of PAD has become a public health crisis because more Americans experience at least one of the associated risk factors: diabetes, high blood pressure, and tobacco use. About 38 million Americans have diabetes, yet one in five people don’t even know it, and these numbers are anticipated to grow. While there has been a reduction in smoking in the U.S., the numbers are still not ideal – nearly 20 percent of Black adults in the U.S. use tobacco products. Lastly, nearly half of all Americans have high blood pressure, which has been an increasing cause for alarm that many physicians are calling to address due to the associated cardiovascular risks.

In addition to the rising number of Americans experiencing risk factors, the PAD crisis can be rooted in two other problems: one, there is a lack of public education on the risks, symptoms, and diagnosis of PAD; and two, many physicians tend to overlook the commonness and severity of PAD. To turn the tide against this devastating disease, we need to rely on physicians to switch their mindset and make sure patients are aware of PAD, akin to other chronic diseases.

Switching the mindset on PAD

There is a common issue with not catching PAD early enough to avoid more progressive stages, resulting in amputation and even death. These repercussions are often preventable, creating another reason for PAD to be taken more critically by physicians and patients.

Patients who have diabetes, high blood pressure, and/or use tobacco should be screened for PAD. Almost all patients who come to primary care doctors above the age of 65 experience one or more of those risk factors. We encourage primary care doctors and other providers to have PAD at the forefront of their minds during these visits because many are beginning to see more patients turning up with amputations.

Physicians can think about PAD earlier by expanding their mindset from just evaluating the initial issue a patient may come in for to checking for PAD in patients with comorbidities. The serious consequences of PAD should justify the importance of this switch in mindset. If a person comes in with a potential PAD diagnosis, they are at high risk for heart attack and stroke. They should be immediately evaluated and treated so their overall risk of a serious cardiovascular event or death decreases. It’s time the health care world should think of PAD as a killer because it is not only of the legs but also lives. Even though a patient may not be bleeding to death, they’re likely clotting to death slowly with PAD.

Importance of awareness

The lack of awareness around PAD stems from one main reason: PAD does not present as intensely as other circular and vascular diseases. When you have a heart attack or a stroke, something very acute happens — someone is calling 9-1-1, and you’re rushed in an ambulance to the hospital. PAD, even though it’s similar in that the blood supply is diminished in the legs (vs. the brain or heart), does not present like that. PAD is a slow burn where, over time, you lose blood supply to your leg, and then suddenly, you wake up one day and have severe pain in your foot, a dead toe, or a wound that’s not healing.

Physicians are educated on PAD, but that education needs to translate to public knowledge of the signs and symptoms, enabling patients to talk with their health care providers. Due to awareness campaigns in recent years, we all know that if you have severe chest pain or notice somebody with a drooping face who can’t smile or speak, call 9-1-1.

However, the awareness around PAD is lacking and has not changed in decades. We need to tell patients that if they have the risk factors or they notice a cut that’s not healing properly or have pain in their foot that’s persistent, talk to their doctor and ask, “Could it be PAD?” A physician will immediately be able to feel their pulse and do a check to see whether PAD might be an issue. Increased awareness can create an impactful snowball effect. The more patients care about PAD and understand how big of an issue it is, the more providers are going to bring it up, the more the government will invest in solutions, and the more lives are saved. All parties need to bring their attention to PAD because it’s been disregarded for too long.

The future of PAD

The good news is that physicians are making strides to combat PAD in this country. Four leading heart and vascular societies (the Association of Black Cardiologists, Society for Cardiovascular Angiography & Interventions, Society of Interventional Radiology, and Society of Vascular Surgery) formed the PAD Pulse Alliance to raise awareness and empower patients to start the conversation with their doctor. The Get a Pulse on PAD campaign aims to educate people on risk factors and potential symptoms, helping guide patients through their PAD journey.

Patients need to be aware of this devasting disease and know the risk factors and symptoms, just like that of a stroke or a heart attack. The government should step in to cover screenings, and it should be second nature for high-risk patients to be screened. Then, we can get patients to a provider earlier to get a diagnostic noninvasive test. We’re not “reinventing the wheel” by calling for increased diligence of PAD. We’ve completed similar processes and campaigns – think about the success cancer and heart attack initiatives have had over the years. Physicians have the influence and skills to prevent the growing number of PAD-related amputations and deaths and now is the time.

Anahita Dua is a vascular surgeon.


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