Gaps in Public Knowledge of Peripheral Arterial Disease

Abstract

Background-Lower-extremity peripheral arterial disease (PAD) is associated with decreased functional status, diminished quality of life, amputation, myocardial infarction, stroke, and death. Nevertheless, public knowledge of PAD as a morbid and mortal disease has not been previously assessed. Methods and Results-We performed a cross-sectional, population-based telephone survey of a nationally representative sample of 2501 adults Ն50 years of age, with oversampling of blacks and Hispanics. The survey instrument measured the demographic, risk factor, and cardiovascular disease characteristics of the study population; prevalent leg symptoms; PAD awareness relative to atherosclerosis risk factors and other cardiovascular and noncardiovascular diseases; perceived causes of PAD; and perceived systemic and limb consequences of PAD. Respondents were 67.2Ϯ12.6 years of age with a high prevalence of risk factors but only a modest burden of known coronary or cerebrovascular disease. Twenty-six percent of respondents expressed familiarity with PAD, a rate significantly lower than that for any other cardiovascular disease or atherosclerosis risk factor. Within the "PAD-aware" cohort, knowledge was poor. Half of these individuals were not aware that diabetes and smoking increase the risk for PAD; 1 in 4 knew that PAD is associated with increased risk of heart attack and stroke; and only 14% were aware that PAD could lead to amputation. All knowledge domains were lower in individuals with lower income and education levels. Conclusions-The public is poorly informed about PAD, with major knowledge gaps regarding the definition of PAD, risk factors that lead to PAD, and associated limb symptoms and amputation risk. The public is not aware that PAD imposes a high short-term risk of heart attack, stroke, and death. For the national cardiovascular disease burden to be reduced, public PAD knowledge could be improved by national PAD public education programs designed to reduce critical knowledge gaps.

Clinical and socioeconomic factors associated with unrecognized peripheral artery disease

“…Third, financial factors can influence a patient's utilization of healthcare, particularly if they choose not to pursue the workup of a condition which is frequently only mildly distressing. 10,33 Last, a patient's mental status can impair a timely diagnosis. Psychologically, a person who is depressed may have functional impairment and be noncompliant, 34 while physiologically, depression may exacerbate endothelial dysfunction, circulating catecholamine levels, and platelet reactivity.…”

“…Furthermore, surveys have shown that physicians feel unfamiliar with PAD demographics, screening and diagnostic approaches. 10,11 Given that secondary prevention measures have been shown to improve outcomes in PAD, 12 cases where the diagnosis of PAD is missed may result in preventable morbidity and mortality.…”

Vascular specialist response to Medicare Evidence Development Coverage Advisory Committee (MEDCAC) panel on peripheral artery disease of the lower extremities

“…2,3 Indeed, history and physical examination have significant limitations in identifying those individuals with PAD, as the majority have atypical symptoms or are considered asymptomatic. 4 This has significant public health implications since PAD is considered a coronary artery disease risk equivalent, and, if unrecognized, carries significant morbidity and mortality. 5 Even those patients with asymptomatic PAD tend to have shorter 6-minute walk test results and poorer functional status.…”

Vascular specialist response to medicare evidence development coverage advisory committee (MEDCAC) panel on peripheral artery disease of the lower extremities

“…Importantly, most of these patients are over the age of 65 years. [2,3] Indeed, history and physical examination have significant limitations in identifying those individuals with PAD, as the majority have atypical symptoms or are considered asymptomatic [4]. This has significant public health implications since PAD is considered a coronary artery disease risk equivalent, and, if unrecognized, carries significant morbidity and mortality [5].…”