The Minnesota Regional Peripheral Arterial Disease Screening Program: toward a definition of community standards of care

Hirsch, Alan T.; Halverson, S. L.; Treat‐Jacobson, Diane; Hotvedt, Peter S; Lunzer, Mary M.; Krook, Susan H.; Rajala, Scott; Hunninghake, Donald B.

doi:10.1177/1358836x0100600204

Cited by 84 publications

(57 citation statements)

References 38 publications

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“…[3][4][5] The burden of PAD falls primarily on the elderly, as it is prevalent in 12-15% of those aged over 65 years and this prevalence is high in individuals with diabetes. [5][6][7][8] While the consequences of PAD are potentially severe, current treatments for PAD can improve quality of life and decrease these adverse health outcomes. 1,5,9 Risk factors for PAD include diabetes, hypertension, high cholesterol, smoking, and obesity, and their treatment could both diminish incident PAD and lower rates of progression and ischemic events.…”

Section: Introductionmentioning

confidence: 99%

National health care costs of peripheral arterial disease in the Medicare population

et al. 2008

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Lower extremity peripheral arterial disease (PAD) is prevalent in the Medicare population and is associated with high rates of myocardial infarction, stroke, amputation, and death. Nevertheless, national health expenditures for PAD are not known. We hypothesized that PAD-related costs are high, increase with age, and that treatment rates would be less than known PAD prevalence. The objective was to determine national health care expenditures for PAD in the United States. PADrelated treatment costs were calculated in the elderly, non-disabled Medicare population. The cost analysis relied on the 5% control population for the linked SEERMedicare data and Medicare claims for the calendar year 2001, identifying PAD cases based on diagnosis and procedure codes. Costs were aggregated separately for inpatient and outpatient treatment and estimates adjusted to reflect the Medicare population. A total of $4.37 billion was spent on PAD-related treatment and 88% of expenditures were for inpatient care. Medicare program outlays totaled $3.87 billion, while enrollees (or their supplemental insurance) spent the remaining $500 million. In total, 6.8% of the elderly Medicare population received treatment for PAD. Treatment increased with age at rates of 4.5%, 7.5%, and 11.8% for individuals aged 65-74, 75-84, and >85 years, respectively. PAD-related costs accounted for approximately 13% of all Medicare Part A and B expenditures for the PAD-treated cohort, and 2.3% of total Medicare Part A and B expenditures. In conclusion, US national PAD-related costs are high, associated with inpatient care, and increase with age. PAD is treated at rates lower than the known PAD prevalence as only approximately one-third of the population with known PAD had detectable PAD-related health care costs in our analysis. The potential impact of earlier PAD detection and use of outpatient preventive strategies on total national PAD health care costs is unknown.

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Section: Introductionmentioning

confidence: 99%

National health care costs of peripheral arterial disease in the Medicare population

et al. 2008

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“…PAD is commonly not diagnosed by primary care and specialty medical services for a number of reasons, an important one of which is the need to perform a time-intensive diagnostic test. 3,8 Doppler ultrasound measurement of the ABI requires specialized equipment, training, and 10 to 15 minutes to perform. These constraints limit the use of this measurement in primary care and specialty offices.…”

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Automated Oscillometric Determination of the Ankle–Brachial Index Provides Accuracy Necessary for Office Practice

2006

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Abstract-Peripheral arterial disease (PAD) remains underdiagnosed by primary care and cardiovascular physicians. The office-based assessment of PAD is limited by the need for specialized equipment and the time required for performance of the ankle-brachial index (ABI). We explored whether the accuracy of automated ABI measurement by oscillometry compared favorably with the gold-standard method using continuous-wave Doppler ultrasound. Consecutive patients referred to our university hospital noninvasive vascular laboratory for ABI measurement were invited for participation. Of 205 patients, 201 participated, including 55 with PAD. The ABI was measured by automated oscillometry and Doppler ultrasound. The test of trends revealed a correlation coefficient of 0.78 in the left leg and 0.78 in the right leg (PϽ0.01 for both). The mean ABI difference between methods was 0.04Ϯ0.01 and 0.06Ϯ0.01, respectively, in the left and right legs. The differences between the methods followed a normal distribution. Key Words: vascular diseases Ⅲ atherosclerosis P eripheral arterial disease (PAD) remains the least recognized and treated form of atherosclerosis. It is present in 5 to 12 million Americans 1,2 but is diagnosed in less than half of these patients. 3 The diagnosis of PAD has important prognostic implications and requires institution of therapeutic lifestyle changes and medical therapy to reduce cardiovascular morbidity and mortality. One important reason that the diagnosis of PAD is made infrequently is the lack of an easy-to-perform diagnostic test.The ankle-brachial index (ABI) is the ratio of the systolic pressure at the ankle compared with the brachial artery pressure. When the ABI is Յ0.9, a diagnosis of PAD is made with up to a 90% accuracy. 4 Measurement of the systolic pressure in both brachial arteries and pedal pulses is performed with a continuous-wave Doppler ultrasound. The greatest barrier to office-based ABI measurement is the time required for testing. 5 A test that is automated, easy to perform, and less reliant on specialized skills may facilitate measurement of the ABI, increasing the diagnosis of PAD in susceptible populations. Oscillometric (automated) determination of blood pressure is approved for blood pressure measurement and is commonly available, reliable, and simple to use. 6 Oscillometers measure the magnitude of the pressure vacillation in the limb as the cuff is deflated from suprasystolic pressures. As the pressure in the cuff decreases and approaches systolic blood pressure, oscillation rapidly increases and eventually reaches a peak after which decrease of the cuff pressure causes the oscillation to decrease. Systolic blood pressure is calculated when the oscillation increases rapidly and the diastolic pressure when the oscillation decreases rapidly. Accordingly, we compared the automated, oscillometric measurement of the ABI to the Doppler ultrasound measurement of the ABI to determine whether there is a simple, fast, and accurate method suitable for common use in the office. Methods Pa...

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“…While in other countries the situation of PAD patients in primary care has been repeatedly addressed (Hirsch et al 2001, Khan et al 2007, corresponding data from the German healthcare system are limited. Against this background, the Patient Care EvaluationPeripheral Arterial Disease (PACE-PAD) Study was initiated.…”

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Outcomes of medical management of peripheral arterial disease in general practice: follow-up results of the PACE-PAD Study

Neumann

Jahn²,

Diehm³

et al. 2010

J Public Health

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Peripheral arterial disease (PAD), a marker of elevated vascular risk, is highly prevalent in general practice. We aimed to investigate patient characteristics and outcomes of PAD patients treated according to the guidelines versus those who were not. Methods. PACE-PAD was a multicentre, cluster-randomised prospective, longitudinal cohort study of patients with PAD in primary care, who were followed-up for death or vascular events over 18 months. Guideline-orientation was assumed, if patients received anti¬coagu¬lant/antiplatelet therapy, exercise training, and (if applicable) advice for smoking cessation and therapy of diabetes mellitus, hypertension, or hypercholesterolemia, respectively. Results. The 5099 PAD patients (mean age 68.0 ± 9.0 years, 68.5% males) who were followed-up were in Fontaine stages I, IIa, IIb, III, and IV in 22.5%, 34.6%, 30.1%, 7.8%, and 3.5% (1.5% not specified). Comprehensive guideline orientation was reported in 28.4% only, however, patients in lower Fontaine stages received more often guideline-oriented therapy (I: 30.3%; IIa: 31.6%, IIb: 29.1%, III: 9.8%, IV: 18.0%). During 18 months, 457 patients died (224 due to cerebrovascular or coronary deaths), 319 had instable angina pectoris, 116 myocardial infarction, and 140 an ischemic stroke event. In total, 24% of patients had experienced any vascular event (19.1% a first event). Event rates did not differ between patients treated according to guidelines, and those who were not. Conclusion. The present PAD cohort was a high-risk sample with an unexpectedly high rate of deaths and vascular events. While physicians appear to focus on the treatment of individual risk factors, rates of comprehensive PAD management in line with guideline recommendations are still suboptimal. Factors contributing to the lacking difference between outcomes in the guideline-oriented and nonguideline-oriented groups may comprise low treatment intensity or other reasons for unsatisfactory effect of treatment, misclassification of events, patient's non-compliance with therapy. Thank you for the thorough review of our above manuscript and your interest in reconsidering it for publication in the Journal of Public Health after having received an appropriate revisions.We have carefully addressed the helpful comments of the reviewer point by point as specified on the next page.We attach the revised text with the changes highlighted in yellow. We hope that the answers are satisfactory to the editors and reviewers and are looking forward to your final decision. Prof. Dr. David PittrowMinor comments:1. Definitions should be given for compliance and adherence to guide readers. Response: The current paper deals with guideline orientation (focus on the physician) rather than on compliance and adherence (focus on the patient). Therefore, we omitted the terms compliance and adherence from the key words, and are now using the term "guideline orientation" consistently throughout the paper. Consequently, the definitions are no longer needed. In addition, we added 2 add...

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The Minnesota Regional Peripheral Arterial Disease Screening Program: toward a definition of community standards of care

Cited by 84 publications

References 38 publications

National health care costs of peripheral arterial disease in the Medicare population

National health care costs of peripheral arterial disease in the Medicare population

Automated Oscillometric Determination of the Ankle–Brachial Index Provides Accuracy Necessary for Office Practice

Outcomes of medical management of peripheral arterial disease in general practice: follow-up results of the PACE-PAD Study

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