Joint Statement on the Importance of Comprehensive, Multidisciplinary and Collaborative Care for Patients with Peripheral Artery Disease from the Association of Black Cardiologists, the American Podiatric Medical Association and the National Black Nurses Association

WASHINGTON, September 22, 2023 /PRNewswire/ – September marks Peripheral Artery Disease (PAD) Awareness Month, providing an excellent opportunity to reinvigorate our efforts in promoting awareness and prevention of this deadly disease. It is the strong belief of the Association of Black Cardiologists, the American Podiatric Medical Association and the National Black Nurses Association that only a collaborative effort from all sectors of society can begin to address this crisis effectively.

In the weeks and months leading up to September, we have been encouraged to see increased dialogue around this disease and the concerted efforts of the many different medical communities and professional societies across the country to raise awareness on how to best prevent and manage it, particularly among our nation’s most vulnerable populations. But dialogue must always lead to action in order to improve patient outcomes and our efforts should not waver from its focus on safeguarding limbs and lives.

PAD is found in 18 to 21 million Americans and severe PAD with critical limb ischemia (CLI)/chronic limb-threatening ischemia (CLTI) that may lead to limb amputation is seen in 11% of adults in the United States. As with other cardiovascular conditions, Black American patients are disproportionately affected by PAD. In one large multi-study analysis, the prevalence of PAD in Black men was more than two-fold than in non-Hispanic White individuals at similar ages. Evidence suggests a similar high prevalence in Black women. Despite widespread prevalence and adverse impact on quality of life, morbidity, and mortality, PAD remains underdiagnosed and undertreated.

The rising limb amputation rates in the United States and the disproportionate impact on Black and Brown communities, both rural and urban, constitute an alarming trend that underscores long-standing and deep-seated disparities in health care access and outcomes, the effects of structural racism, and inadequate provider-patient awareness of evidence-based PAD management strategies.

The multifaceted nature of the PAD/CLI and amputation epidemic requires improved healthcare access, education, early detection, and culturally competent care, all aimed at breaking the devastating cycle of limb amputation among Black Americans. Limb amputations not only cause profound physical and emotional suffering but also perpetuate cycles of socioeconomic disadvantage, with impacts extending beyond the individual to families and communities, perpetuating a cycle of health inequity.

People with PAD require a comprehensive, patient-centered approach to minimize the complications associated with under-recognition and inadequate management of atherosclerotic cardiovascular disease, specifically heart attack, stroke, diabetes and chronic kidney disease. A multidisciplinary team-based approach to care has become indispensable within the cardiovascular care provider community, leveraging the expertise of various professionals to ensure patient continuity of care and cultivate enduring and impactful patient-provider relationships. Not only does this foster trust and satisfaction among patients, but it also enriches the specialists’ understanding of the social and cultural factors that can influence health outcomes in a given region.

In order to establish an effective patient-centered care program focused on enhancing mobility, promoting wound healing, and most importantly, preventing amputations and reducing cardiovascular risk, it is essential to implement comprehensive multispecialty care. This approach involves a collaborative team consisting of general cardiologists, primary care clinicians, interventional cardiologists, vascular surgeons, interventional radiologists, vascular medicine specialists, wound care specialists, podiatrists, advanced practitioners, nurses, therapists, and vascular technicians. Together, they play a crucial role in the collective effort to combat avoidable amputations and enhance overall patient well-being.

Unfortunately, one barrier to this kind of care is a critical shortage of these types of specialists in underserved regions, leading to maldistribution of care and undertreatment of countless individuals. This underscores the need for innovative solutions to providing improved access to multidisciplinary care and highlights one of the reasons why change must come from multiple sectors. No one group alone can make a sustainable impact on this public health crisis alone.

The ABC and our partners will persist and strive to make meaningful change in the PAD epidemic through multiple channels. We continue to develop and improve our patient education and community outreach resources to empower individuals and communities disproportionately affected by PAD with the knowledge and tools needed to prevent, diagnose and manage this disease. Additionally, ABC-led PAD roundtables periodically convene diverse stakeholders including physicians, patient advocates, community and faith-based leaders and advocacy organizations to thoughtfully address challenges and barriers to diagnosis and initiate timely treatment of PAD in the Black American population. And the organization continues to advocate for policy and resources to improve equitable enrollment for Black Americans in clinical trials of PAD therapies.

With the establishment of The Congressional Peripheral Artery Disease Caucus in 2019, we work to educate Congress and garner support for legislative activities to improve PAD research, education, and treatment with the explicit goal of preventing non-traumatic amputations due to PAD and other related diseases. These efforts received needed support with the recent re-introduction of the Amputation Reduction and Compassion (ARC) Act, a bipartisan bill that requires Medicare and Medicaid to fully cover screening tests for beneficiaries who are at-risk of PAD.

We believe only by working together can we make a significant impact in reducing amputations caused by PAD and CLI/CLTI. As a multi-society and cross-specialty coalition we work tirelessly in concert to highlight respective approaches to reducing disparities in health care access, treatment and outcomes, and provide advocacy for and awareness of specialized care for communities in need. Our hope is that the recent uptick in discussion and awareness around PAD – along with the efforts during PAD Awareness Month, and beyond – renews the attention to improving care for our patients with PAD, particularly those most vulnerable to its ravages.

Anekwe E. Onwuanyi, MD, FACC, President, Association of Black Cardiologists; Sylvia Virbulis, DPM, President, American Podiatric Medical Association; Sheldon D. Fields, PhD, RN, CRNP, FNP-BC, AACRN, FAANP, FNAP, FAAN, President, National Black Nurses Association


Co-authored by Foluso Fakorede, MD, Co-Chair, ABC PAD Initiative; Lee Kirksey, MD, Co-Chair, ABC PAD Initiative; Paul Douglass, MD, Past ABC President and Interventional Cardiology specialist; Aaron Horne, MD, Past ABC Board Member and Interventional Cardiology specialist; Paul Underwood, MD, Past ABC President and Co-Chair, ABC Community Programs Committee; Sara Collins, MD, Co-Chair, ABC Health and Public Policy Committee; Jennifer Ellis, MD, Co-Chair, ABC Health and Public Policy Committee; Anekwe E. Onwuanyi, MD, President of ABC; and Barbara Hutchinson, MD; ABC Board Chair.

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