According to a new American Heart Association scientific statement published today in the Association’s premier, peer-reviewed journal Circulation, the criteria for success for the roughly 8.5 million Americans with peripheral artery disease (PAD, pronounced P-A-D), which is characterised by narrowed or clogged arteries in the legs, should be driven by their symptoms.
A scientific statement from the American Heart Association is a professional evaluation of recent findings that could influence future practice recommendations.Managing peripheral artery disease (PAD) based on a person’s experience of symptoms can result in more patient-centred care and outcomes, with a focus on high-value care, compared to relying on clinical measures like the rate of blood flow to the legs or artery diameter. This is highlighted in the statement, “Advancing peripheral artery disease quality of care and outcomes through patient-reported health status assessment.”
“The person living with peripheral artery disease is the authority on its impact on their daily life. Our treatment must be grounded in their lived experiences and go beyond the clinical measures of how well blood flows through the arteries,” said Vice Chair and lead author of the statement writing group Kim G. Smolderen, PhD, a clinical psychologist and an associate professor of medicine and psychiatry and co-director of the Vascular Medicine Outcomes Research (VAMOS) lab at Yale University in New Haven, Connecticut.
“We have spent years developing and validating standardized instruments to capture people’s experiences in a reliable and sensitive way. We are now at a point where we can start integrating this information into real-world care, through pilot programs that can develop quality benchmarks for different phenotypes of patients with PAD and the types of treatments they undergo, as seen from their perspective.”
Painful Legs and Other Patient Experiences
Although those who have peripheral artery disease (PAD) tend to be older than 40, it can also affect younger people. People with PAD have blockages in the arteries that carry blood to their legs and feet, which frequently results in pain, cramping, or weakness when they walk, necessitating a brief break to ease the discomfort. Although some people have no symptoms, many patients may only have no pain because they restrict their activities.
Their functionality and health status are also impaired, according to studies. People who have critical limb ischemia, or highly restricted blood supply to the legs, may endure discomfort even while at rest, have wounds that do not heal or develop gangrene that could result in an amputation.
Another risk factor for heart attack or stroke is PAD.
The everyday functioning and quality of life of patients are significantly impacted by all of these manifestations, with the impact growing as the disease’s severity rises. Other medical diseases like Type 2 diabetes, coronary artery disease, kidney dysfunction, or mental health issues like depression or stress-related illnesses that are frequent in persons with PAD can have an impact on outcomes, according to Smolderen.
Coordination of care for risk factors and patient concerns is prioritised when the healthcare team is more aware of the impact of disease on quality of life. The statement urges gathering feedback from patients’ therapy experiences to enhance and personalise care for those with obstructed leg arteries.Patient-reported outcomes measures (PROMs) are a systematic and proven approach of directly asking patients to rate how their symptoms, physical, social, and emotional functioning, and quality of life are affected by their disease. PROM feedback can be used to more accurately and impartially evaluate the quality of care provided to PAD patients.
The use of PROMs has several key advantages, including increasing comprehension of the patient’s lived experience with PAD; enhancing patient self-management of symptoms and medical needs; standardising quality performance benchmarks for practices that treat patients with PAD, and delivering pertinent feedback to identify treatment changes or needs.
It may be possible for physicians to consider beyond a specific intervention by calling more attention to quality-of-life issues or cardiovascular risk factors when patients are included as the expert on their own experiences. This viewpoint could spark discussions that change the course of therapy or introduce patients to additional treatments like behavioural health services, wound care, or smoking cessation. Self-management and joint decision-making between patients and physicians may be improved by patient-centred care.
No matter the patient’s literacy level, language obstacles, or cultural norms, all of these advantages are attainable as long as the patient-reported outcome measures are evaluated using methods that the patient is able to grasp. It’s also crucial that PROMs are carried out by professionals who are qualified and knowledgeable enough to use the tools, interpret the results, and connect patients with further resources. The claim gives examples of PROMs that assess depressive symptoms, general health status, PAD-specific health status, and leg pain and functioning (including walking limitation).
Performance Measures to Improve Quality of Care
PROMs might potentially be used to evaluate whether programmes are offering persons with PAD high-quality care. PROMs are increasingly being incorporated into definitions of what it means to give patient-centred, high-quality clinical care, and PROMs scores may have a direct impact on reimbursement, according to the Centers for Medicare and Medicaid Services and the National Quality Forum. PROMs are converted into Patient-Reported Outcomes Performance Measures for programme evaluation (PRO-PMs).
The use of PRO-PMs has the potential to:
a. offer quantifiable goals for programmes to improve their quality of care;
b. encourage the development of training and expertise for health systems to administer, interpret, and use PRO-PMs in an ethical manner to improve patient care;
c. lessen disparities in care and promote health equity;
d. assist in the development of national standards for quality care.
“This roadmap highlights a paradigm shift that places the patient experience front and centre, which is a departure from the status quo. It is provocative to now place the lived experience with the disease at the forefront, engaging people with PAD to provide information that holds health systems and practitioners accountable as to whether high-quality care was delivered, in addition to assessing the safe and effective delivery of current evidence-based treatments,” said Smolderen.
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