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Dec 3, 2019
CVC urges USPSTF to update PAD screening recommendations to include at-risk populations to prevent amputation, reduce healthcare costs, and eliminate racial disparities
WASHINGTON – The CardioVascular Coalition (CVC), a consortium of physicians, care providers, advocates, and manufacturers working to improve awareness and prevention of peripheral artery disease (PAD), released a new white paper urging the United States Preventative Services Task Force (USPSTF) to revisit its PAD screening recommendation guidelines. The white paper, Mind the Gap: The Case for Screening High-Risk Communities for PAD, argues recommendations should be updated to ensure Americans at high risk of developing the disease have better access to screening, which has been shown to significantly improve patient outcomes by preventing amputation.
The USPSTF has consistently found “insufficient evidence to assess the balance of benefits and harms” of the ankle-brachial index (ABI) screening methodology. However, this assessment is flawed because the USPSTF focused its guidelines on PAD screening for the general population (i.e. Americans of all ages, ethnic and racial backgrounds, socioeconomic status, and health histories), while ignoring the increased risk factors that certain populations face. This conclusion makes it significantly less likely that minorities, people with a history of diabetes or cardiovascular disease, and individuals in high-risk communities will be screened for PAD until it is too late to save their limbs.
Screening and early detection has been shown to reduce the probability of an amputation due to PAD by 90 percent but is greatly underutilized, as only 12.5 percent of patients with PAD are identified by physicians and treated. Overall, a majority of the estimated 200,000 annual non-traumatic amputations that occur in the United States every year can be avoided with the proper care.
Across the country, approximately 20 million Americans have been diagnosed with PAD, including 1 in 20 Americans over the age of 50. When common risk factors such as diabetes and nicotine use are included in the analysis of prevalence, as many as one-third of patients are estimated to suffer from the disease. Similarly, more than 30 million Americans with diabetes and an additional 84.1 million Americans with prediabetes are at an elevated risk of developing PAD in their lifetimes.
Moreover, a growing body of research shows that ethnic and racial minorities have a substantially greater risk of developing PAD and requiring amputations than their white counterparts. For example, African American patients with diabetes are more than three times as likely to have their limbs surgically removed than their white counterparts. Native Americans in the western U.S. are twice as likely to suffer from PAD than white Americans, while Hispanics are 75 percent more likely to develop the disease. While all older Americans tend to be more susceptible to PAD than younger Americans, elderly patients of color suffer from a disproportionately high rate of PAD.
In the white paper, CVC urges the USPSTF to revisit its recommendation on PAD screening and review the data as it relates to PAD screening for at-risk populations, including those with a history of smoking, diabetes, and other cardiovascular diseases. By recognizing that at-risk populations are more vulnerable to PAD than the general population, USPSTF should seize the opportunity to improve patient outcomes, reduce long-term healthcare costs, and eliminate racial disparities in the cardiovascular space.
To read Mind the Gap: The Case for Screening High-Risk Communities for PAD, click here.