Top Things to Know: The Association Between Mental Health Burden, Clinical Presentation, and Outcomes in Individuals with Symptomatic PAD
Published: October 02, 2023
Prepared by Barbara Entl, MD
- The global prevalence of lower extremity peripherally artery disease (PAD) is estimated to be over 200 million, with increasing incidence due to rising rates of obesity and diabetes, one of the most substantial risk factors for PAD.
- Patients with PAD often have co-occurrence of mental health conditions which pose significant challenges for the successful management of both conditions.
- This scientific statement provides a framework for evaluating mental health as part of the overall disease management strategies for patients with PAD.
- A summary of risk factors associated with mental health and incident PAD is included, as well as psychological interventions integrating psychosocial factors with special consideration of the PAD pathophysiology and disease management.
- Further, the statement provides an overview of the role of pain, health behaviors that impact the progression or prevention of PAD, and broader impacts of illness and adaptation to living.
- Pain, especially chronic persistent ischemic, in individuals with chronic limb-threatening ischemia (CLTI) often impacts patients’ functioning and increases the risk of opioid dependency. In fact, one in four patients diagnosed with PAD meets the criteria for high opioid use. The risk of high opiate use is also increased in individuals with major depression, nicotine use, and post-traumatic stress disorder.
- Psychosocial risk factors such as negative illness perceptions, depression, anxiety, and perceived stress play a crucial role in overall PAD outcomes and functioning.
- PAD management strategies include recognizing mental health, integrating mental health care in peripheral vascular disease management, and understanding pathophysiological mechanisms that connect trauma and distress to worse PAD outcomes.
- Recognition of mental health conditions through early screening during patients’ health care visits, followed by early intervention and engagement of a multidisciplinary team, will help mitigate the risks associated with mental health conditions in patients with PAD.
- The mental and vascular health relationship is essential and requires collaboration between vascular specialists, health psychologists, psychiatrists, and behavioral health professionals. This scientific statement is, therefore, timely and critical to recognizing that medical and behavioral health specialists are crucial in improving health in patients with peripheral artery disease.
Citation
Smolderen KG, Samaan Z, Decker C, Collins T, Lazar RM, Itoga NK, Mena-Hurtado C; on behalf of the American Heart Association Council on Peripheral Vascular Disease; Council on Cardiovascular and Stroke Nursing; Council on Clinical Cardiology; Council on Lifestyle and Cardiometabolic Health; and Council on Quality of Care and Outcomes Research. Association between mental health burden, clinical presentation, and outcomes in individuals with symptomaticperipheral artery disease: a scientific statement from the American Heart Association [published online ahead ofprint October 2, 2023]. Circulation. 2023;148:e•••–e•••. doi: 10.1161/CIR.0000000000001178