PAD Performance Measures Issued by ACC/AHA Task Force

November 29, 2010—The American College of Cardiology/American Heart Association (ACC/AHA) Task Force on Performance Measures issued the first-ever performance measures for adults with peripheral artery disease (PAD). These new performance measures aim to systematically improve the diagnosis and treatment of PAD, help prevent cardiac events and premature death, increase understanding of the serious heart-related effects of PAD within the health care community at large, and facilitate reimbursement of evidence-based practices.

The performance measures have been published online ahead of print in the December 14/21, 2010, issue of the Journal of the American College of Cardiology and co-published in the December 14, 2010, issue of Circulation: Journal of the American Heart Association, the Journal of Vascular Nursing, the Journal of Vascular Surgery, and the Vascular Medicine Journal.

“Patients with PAD have the highest rate of heart attacks, stroke, and cardiovascular death—higher than people with coronary artery disease—yet they remain undertreated,” commented Jeffrey W. Olin, DO, chair of the writing committee. “Therapies simply aren't given with the same intensity. These patients receive antiplatelet therapy or statin therapy much less frequently than patients with coronary artery disease despite their high cardiovascular event rate.”

Dr. Olin added, “Even when PAD is diagnosed, many health care providers will often just treat the leg symptoms—for example, any leg pain, tightness, or cramping the patient might report—and not the heart-related risks. Once PAD is diagnosed, appropriate therapy can be instituted to improve the ability to walk further and faster without pain and lower the rate of heart attack, stroke, and death from cardiovascular causes.”

According to the ACC/AHA, the new performance measures are intended to help ensure earlier diagnosis and more appropriate modification of cardiovascular risk factors among patients with PAD. The selection of performance measures was based on a thorough evaluation of the evidence base for a given measure, the ease and/or complexity of measurement, and whether the measurement was covered in previously published measurement sets. The writing committee included experienced clinicians and specialists in vascular medicine, cardiology, vascular surgery, exercise physiology, vascular and interventional radiology, interventional cardiology, endocrinology, and epidemiology.

The set of performance measures includes the use of:

• Ankle brachial index (ABI) in patients deemed at risk
• Statin therapy to lower the LDL cholesterol to less than 100 mg/dL
• Smoking cessation interventions to help active smokers quit
• Antiplatelet therapy with aspirin or clopidogrel to reduce risk of heart attack, stroke, or death in people with history of symptomatic PAD
• Supervised exercise programs that are similar to cardiac rehabilitation for patients who have had a heart attack or coronary bypass surgery
• Lower extremity vein bypass graft surveillance with periodic ABI and ultrasound
• Monitoring of abdominal aortic aneurysms

The task force expects that these performance measures, once incorporated into routine practice, will improve patients' overall well-being, quality of life, and pain-free walking distance and speed, as well as reduce heart attack, stroke, and death. As more clinicians adopt these practices more widely, the hope is that reimbursement of ABI and supervised exercise programs, which are not currently reimbursed, will follow.

According to Dr. Olin, “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%, and their walking speed also increases. This is more than can be achieved with any medication that is available on the market.”