Top Things to Know: Reducing Nontraumatic Lower-Extremity Amputations by 20% by 2030: Time to Get to Our Feet
Published: March 25, 2021
- Non-traumatic lower-extremity amputation is a devastating complication of peripheral artery disease (PAD) with high mortality and medical expenditure.
- There are ~150,000 non-traumatic leg amputations every year in the US, and most cases occur in patients with diabetes. Among diabetic patients, after a ~40% decline between 2000 and 2009, amputation rate increased by 50% from 2009 to 2015.
- There are a number of evidence-based diagnostic and therapeutic approaches for PAD that can reduce amputation risk. Yet, their implementation and adherence are suboptimal.
- Racial/ethnic minorities have elevated risk of PAD, but less access to high-quality vascular care, leading to increased rates of amputation.
- To stop, and indeed reverse, the increasing trends of amputation, actionable policies that will reduce incidence of critical limb ischemia and enhance delivery of optimal care are needed.
- This statement describes the impact of amputation on patients and society, summarizes medical approaches to identify PAD and prevent its progression, and proposes policy solutions to prevent limb amputation.
- Among the actions recommended are improving public awareness of PAD and greater use of effective PAD management strategies (e.g., smoking cessation, use of statins, and foot monitoring/care in diabetic patients).
- To facilitate the implementation of these recommendations, the AHA proposes several regulatory/legislative and organizational- and institutional-level policies.
- These include adoption of quality measures for PAD care, affordable prevention, diagnosis, and management, regulation of tobacco products, and clinical decision support for PAD care, professional education, and dedicated funding opportunities to support PAD research.
- If these recommendations and proposed policies are implemented, it may be possible to achieve the goal of reducing the rate of non-traumatic lower-extremity amputations by 20% by 2030.
Citation
Creager MA, Matsushita K, Arya S, Beckman JA, Duval S, Goodney PP, Gutierrez JAT, Kaufman JA, Joynt Maddox KE, Pollak AW, Pradhan AD, Whitsel LP; on behalf of the American Heart Association Advocacy Coordinating Committee. Reducing nontraumatic lower-extremity amputations by 20% by 2030: time to get to our feet: a policy statement from the American Heart Association [published online ahead of print March 25, 2021]. Circulation. doi: 10.1161/CIR.0000000000000967