November 30th, 2010
New Performance Measures for Peripheral Artery Disease Issued
Larry Husten, PHD
Performance measures to improve the diagnosis and treatment of peripheral artery disease (PAD) in adults have been published for the first time. The document was produced by the ACC, the AHA, and several other medical organizations. Here are a few key details of the performance measures:
- Measuring the ankle brachial index (ABI) is an easy and inexpensive way to screen for PAD.
- Statin therapy should be used to lower LD below 100 mg/dL.
- Smokers should receive support to quit smoking.
- Antiplatelet therapy should be used in people with a history of symptomatic PAD.
- Supervised exercise programs, like cardiac rehabilitation programs for MI or CABG patients, increase walking distance and reduce cardiovascular risk.
- People with a lower extremity vein bypass graft should undergo periodic ABI measurement and ultrasound to determine whether the conduit continues to function.
- Abdominal aortic aneurysms should be monitored.
“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 Olin, chair of the writing committee, in an ACC press release. “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.”
Olin also emphasized the value of, and the difficulty of delivering, exercise therapy for PAD patients: “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…. This is more than can be achieved with any medication that is available on the market.”
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