CITATIONS: 1.
6. In, et al. 18TH CONGRESS 1ST SESSION to Amend Titles XVIII and XIX of the Social Security Act to Provide for Coverage of Peripheral Artery Disease Screening Tests Furnished to At- Risk Beneficiaries under the Medicare and Medicaid Programs without the Imposition of Cost-Sharing Requirements, and for Other Purposes. 2023.
PERIPHERAL ARTERY DISEASE: A CLUE TO POLY-VASCULAR DISEASE IN NEED OF FEDERAL LEGISLATIVE RECONSIDERATION
Aday, Aaron W., and Kunihiro Matsushita. “Epidemiology of Peripheral Artery Disease and Polyvascular Disease.” Circulation Research , vol. 128, no. 12, 11 June 2021, pp. 1818–1832, https://doi.org/10.1161/circresaha.121.318535. 2. Ohman, E. Magnus, et al. “The REduction of Atherothrombosis for Continued Health (REACH) Registry: An International, Prospective, Observational Investigation in Subjects at Risk for Atherothrombotic Events-Study Design.” American Heart Journal , vol. 151, no. 4, Apr. 2006, pp. 786.e1–786.e10, https://doi.org/10.1016/j. ahj.2005.11.004. Accessed 22 Oct. 2020. 3. “Recommendation | United States Preventive Services Taskforce.” www.uspreventiveservicestaskforce.org, www.uspreventiveservicestaskforce.org/uspstf/ recommendation/peripheral-artery-disease-in-adults- screening-with-the-ankle-brachial-index. 4. Gerhard-Herman, Marie D., et al. “2016 AHA/ACC Guideline on the Management of Patients with Lower Extremity Peripheral Artery Disease: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines.” Circulation , vol. 135, no. 12, 21 Mar. 2017, www.ahajournals. org/doi/pdf/10.1161/CIR.0000000000000470, https://doi. org/10.1161/cir.0000000000000470.
7.
“Peripheral Matters | Peripheral Artery Disease: Moving from Awareness to Action.” American College of Cardiology, www.acc.org/Latest-in-Cardiology/ Articles/2023/09/01/01/42/peripheral-matters-peripheral- artery-disease-moving-from-awareness-to-action. Accessed 25 Nov. 2023.
Authored by: Omar Leonards, MD LSUHSC-New Orleans Cardiovascular Disease Fellow
8. Scully, Rebecca E., et al. “Estimated Annual Health Care Expenditures in Individuals with Peripheral Arterial Disease.” Journal of Vascular Surgery , vol. 67, no. 2, 1 Feb. 2018, pp. 558–567, www.ncbi.nlm.nih.gov/ pubmed/28847660, https://doi.org/10.1016/j.jvs.2017.06.102. 9. Mahoney, Elizabeth M., et al. “Vascular Hospitalization Rates and Costs in Patients with Peripheral Artery Disease in the United States.” Circulation: Cardiovascular Quality and Outcomes , vol. 3, no. 6, Nov. 2010, pp. 642–651, https:// doi.org/10.1161/circoutcomes.109.930735. Accessed 21 Oct. 2020 10. U.S. Bureau of Labor Statistics. “CPI Inflation Calculator.” U.S. Bureau of Labor Statistics , www.bls.gov/data/inflation_ calculator.htm.
Peripheral artery disease (PAD) is a condition that affects approximately 236 million adults, with an estimated 8.5 million Americans being affected nationally; however, there is a need for more contemporary data.1 Though data linking race to incident PAD is limited, the lifetime estimated risk of PAD is highest amongst African Americans and non-Hispanic whites. 1 Despite the global and national prevalence of PAD, it remains underappreciated in comparison to coronary artery disease (CAD) and cerebrovascular disease (CVD). 1 Data from the REduction of Atherothrombosis for Continued Health (REACH) Registry highlights that PAD is not simply narrowed arterial vasculature but a clue of possible poly- vascular disease. 2 Despite the national prevalence of the disease and objective data from the REACH Registry, the United States Preventative Service Task Force (USPSTF) concluded there is insufficient data to screen asymptomatic individuals for PAD with an ankle-brachial index. However, supporting recommendations are found in the 2016 AHA/ACC Guidelines on the Management of Patients with Lower Extremity Peripheral Artery Disease. 3,4 This leaves millions of at-risk Americans vulnerable to the potential long-term morbidity and mortality not only associated with PAD but also potential poly-vascular disease, as the Centers for Medicare and Medicaid Services (CMS) only provides full benefit coverage for USPSTF grade A and B screening recommendations. This vulnerability in the healthcare of all Americans has ignited multiple cardiovascular disease organizations across the United States to spearhead awareness campaigns and work with federal lawmakers in supporting the introduction of legislation to address this healthcare gap. Initially founded in 2019, the Congressional Peripheral Artery Disease (PAD) Caucus was formed to educate Congress and communities about PAD and support federal initiatives in preventing PAD-related morbidity and mortality. The bipartisan caucus co-chairs include Representatives Donald M. Payne, Jr. (D-NJ) and Gus Bilirakis (R-FL). The caucus’s initiatives for this 118th Congress include the reintroduction of the Amputation Reduction and Compassion (ARC) Act, requesting the USPSTF review screening guidelines in at-risk patients, and encouraging the creation of intragovernmental workgroups to implement a comprehensive amputation prevention program for PAD patients in Medicare and other federal programs based on the US Department of Veterans Affairs Preventing Amputations in Veterans Everywhere (PAVE) program. 5
June 21, 2023, is referred to the Subcommittee on Health. This legislation seeks to amend titles XVIII and XIX of the Social Security Act to provide coverage for PAD screening tests to at-risk beneficiaries under the Medicare and Medicaid programs without imposing cost-sharing requirements. “At-risk beneficiaries” include those listed in the 2016 AHA/ACC Guidelines on the Management of Patients with Lower Extremity Peripheral Artery Disease. 4,6 Furthermore, this legislation amends Part P of Title III of the Public Health Service Act 8 (42 USC 280g et seq.) and tasks the Secretary of Health and Human Services to work with other federal agencies and stakeholders to implement a PAD education program. The bill appropriates 6 million dollars annually from fiscal years 2024-2028 to carry out these tasks. Though the appropriations will initially cost American taxpayers 24 million dollars, the return on investment is arguably undeniable. The realized return on investment can be appreciated by understanding the fiscal strain PAD and its most severe form, chronic limb-threatening ischemia (CLTI), place on the United States healthcare system. CLTI can lead to ulcerations, gangrene, and ultimately amputation, with one-year rates of amputation reaching as high as 22% and increasing mortality rates to approximately 35-48% within one year. 7 In a review of health care related expenditure data from 2011 to 2014, the Agency for Healthcare Research and Quality Medical Expenditure Panel estimated a greater than $7000 increase in healthcare-related cost per year in each patient diagnosed with PAD in comparison to US adults 40 years of age and older without PAD when adjusted for age, gender, and race. 8 Vascular-related hospitalization in patients with PAD based on 2004 US census data was estimated to cost more than $21 billion annually, which is now greater than $33 billion annually, adjusting for inflation based on consumer price index estimates. 9, 10 Despite PAD being responsible for the highest healthcare- related cost in cardiovascular disease and worse quality of life (QOL), it continues to be underrecognized and undertreated. 7 The REACH Registry provides a clear insight into the relationship of PAD with other polyvascular diseases, and current USPSTF recommendations are incongruent with the 2016 AHA/ACC PAD guidelines. 2,3,4 This leaves millions of at-risk Americans vulnerable to the long-term outcomes of underrecognized and untreated atherosclerotic disease; thus, it is imperative that federal legislation be enacted to improve healthcare-related outcomes of the American people. ■
5. “Congressional PAD Caucus.” Congressman Donald Payne , 18 Feb. 2020, payne.house.gov/pad-caucus.
The ARC Act (HB 4261), introduced in this 118th Congress on
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J LA MED SOC | VOL 176 | FALL 2024
J LA MED SOC | VOL 176 | FALL 2024
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