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, et al.
Circulation. Date of publication 2021 Apr 27;volume 143(17):e875-e891.
1. Circulation. 2021 Apr 27;143(17):e875-e891. doi: 10.1161/CIR.0000000000000967.
Epub 2021 Mar 25.
Reducing Nontraumatic Lower-Extremity Amputations by 20% by 2030: Time to Get to
Our Feet: A Policy Statement From the American Heart Association.
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.
Nontraumatic lower-extremity amputation is a devastating complication of
peripheral artery disease (PAD) with a high mortality and medical expenditure.
There are ≈150 000 nontraumatic leg amputations every year in the United States,
and most cases occur in patients with diabetes. Among patients with diabetes,
after an ≈40% decline between 2000 and 2009, the amputation rate increased by 50%
from 2009 to 2015. A number of evidence-based diagnostic and therapeutic
approaches for PAD can reduce amputation risk. However, their implementation and
adherence are suboptimal. Some racial/ethnic groups have an 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 the 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 (eg, smoking cessation,
use of statins, and foot monitoring/care in patients with diabetes). To
facilitate the implementation of these recommendations, we propose several
regulatory/legislative and organizational/institutional policies such as adoption
of quality measures for PAD care; affordable prevention, diagnosis, and
management; regulation of tobacco products; clinical decision support for PAD
care; professional education; and dedicated funding opportunities to support PAD
research. If these recommendations and proposed policies are implemented, we
should be able to achieve the goal of reducing the rate of nontraumatic
lower-extremity amputations by 20% by 2030.
DOI: 10.1161/CIR.0000000000000967
PMID: 33761757
