What Is PAD?
Peripheral artery disease (PAD) is a condition in which narrowed arteries reduce blood flow to the arms or legs. An estimated 20 million Americans suffer from PAD, largely in rural and underserved communities, but many are not aware that they have the disease until drastic medical intervention is required. A severe form of PAD known as critical limb-threatening ischemia (CLTI) is a leading cause of the 150,000 preventable amputations that occur each year in the United States, raising medical costs, harming patients’ health, and leading to unnecessary deaths. Fortunately, solutions exist — increase screening for PAD, educate doctors and the public about the disease, and ensure a robust Medicare program that makes care accessible for all.
Care for patients with PAD and CLTI is typically complex, multifaceted, and multidisciplinary, and a team approach should be used in most cases. Interventional cardiologists play a fundamental role in this team approach. Through revascularization, a minimally invasive procedure, interventional cardiologists can restore blood flow in patients suffering from PAD/CLTI and avoid amputation.
An increasingly important area to address for policymakers is health outcomes in America’s growing rural minority population, which grew from 20.2 percent of rural America in 2010 to 24 percent in 2020. Rural areas with high minority populations, most common in Southern and Western states, often face some of the lowest levels of access to care for PAD. Federal action would be most impactful for these communities.
Key Facts
- 33% of PAD patients will die within 5 years of their diagnosis and 20% will experience a heart attack or stroke.
- The total annual economic burden of PAD is estimated between $233-414 billion.
- Black Medicare beneficiaries are three times more likely to receive an amputation due to PAD than non-Black Medicare recipients.
- In 2015, Americans spent $11.3 billion on major amputations and $18.6 billion on minor amputations.
- Between 52%-80% of patients who undergo a major amputation die within five years of the procedure.
- Despite the high economic and human cost of PAD, screening is currently not recommended by the US Preventive Services Task Force.
National Action Plan
What Can Congress Do?
The Amputation Reduction and Compassion (ARC) Act, H.R.4261, introduced by Reps. Donald M. Payne, Jr. (D-NJ) and Jeff Van Drew (R-NJ) and cosponsored by the bipartisan chairs of the PAD Caucus, would be a major step forward for PAD patients. Key provisions include:
- Require Medicare, Medicaid, and group health insurance plans to cover screenings for individuals at high risk for developing PAD.
- Establish a PAD education program through the US Department of Health and Human Services (HHS) to support, develop, and implement educational incentives to expand the understanding of PAD for healthcare professionals and the public, with a particular emphasis on at-risk populations.
Congress must also implement a sustainable and equitable Medicare physician payment program that supports office-based specialty care, including the interventional cardiologists who treat PAD and prevent amputations.
Please see the attached statement signed by the Society for Cardiovascular Angiography and Interventions and the Outpatient Endovascular and Interventional Society.