Report on a Program to Improve Vascular Care for Women: Experience in 68,402 Patients Seen in Primary Care Clinics

Abstract

Background: Lower extremity peripheral artery disease (PAD) affects at least 8.5 million people nationwide, causing 143,000+ hospitalizations and 40,000 amputations annually. Women with PAD have a higher chance of being asymptomatic or present with atypical symptoms. Fewer than half of affected women know they have PAD, and studies illustrate an expected increase in under-diagnoses in these women. Women with PAD are two to three times more likely to experience stroke or myocardial infarction (MI). This is the first report on the clinical feasibility of using a specialized volume plethysmography system (VPS) as operated by a medical aide in the primary care setting to perform PAD testing on female patients. Methods: In 2018, consecutive female patients in primary care settings were evaluated for the presence or absence and severity of PAD. Beforehand, the patients completed a self-administered questionnaire to identify gender, age, PAD symptoms, and atypical cardiovascular factors. Medical aides performed the test as part of routine clinical practice and presented results to primary care physicians who made the diagnosis based upon test findings. Results: Of the 68,402 patients who met the American Heart Association/American College of Cardiology criteria and were tested in the primary care setting, 26,576 or 38.9% had moderate to severe PAD. These patients were frequently asymptomatic, hypertensive, hyperlipidemic, diabetic, and/or had a history of tobacco smoking. Conclusion: VPS is an accurate, reproducible, cost-effective, and clinically feasible in-office or home visit test allowing for detection of PAD in women earlier in the disease process.