New joint guidelines from the AHA/ACC have been released for the management of lower extremity peripheral artery disease and have been published simultaneously in Circulation and the Journal of the American College of Cardiology. The new guideline, which was developed with and endorsed by a number of other societies, updates the recommendations made in the 2016 version with new evidence to guide clinicians and additional recommendations addressing comprehensive care for patients with peripheral artery disease (PAD).
The new guideline identifies four clinical subsets of PAD: asymptomatic PAD (which may still involve functional impairment), chronic symptomatic PAD (including claudication), chronic limb-threatening ischemia and acute limb ischemia. The guideline highlights the link between health disparities in PAD and poor limb and cardiovascular outcomes, and the importance of interventions being coordinated between multiple stakeholders across the cardiovascular community and public health infrastructure at both patient and population level.
To prevent major adverse cardiovascular and limb events in PAD patients, effective medical therapies should be prescribed. These include antiplatelet (generally single antiplatelet) and antithrombotic therapy, lipid-lowering treatments (such as high-intensity statins), antihypertensive therapy, diabetes management and smoking cessation. Rivaroxaban (2.5 mg twice daily) combined with low-dose aspirin (81 mg daily) is particularly effective for patients not at increased risk of bleeding.
The guideline highlights structured exercise as a fundamental component of PAD care, encompassing supervised exercise therapy and community-based or structured home-based programs.Â
Revascularization (endovascular, surgical or hybrid) is recommended to prevent limb loss in those with chronic limb-threatening ischemia and to improve quality of life and functional status in patients with claudication unresponsive to medical therapy and structured exercise.
The guideline promotes the multispecialty care team for optimal care for PAD patients, particularly those with chronic limb-threatening ischemia. Foot care is essential across all clinical subsets of PAD, ranging from preventive care and patient education to advanced treatments in cases of chronic limb-threatening ischemia. Podiatrists and other specialists in foot care, wound healing, and foot surgery are vital members of this team.
Finally, the PAD National Action Plan sets out six strategic goals to enhance awareness, detection, and treatment of PAD across the nation with implementation of this action plan deemed a top advocacy priority for the writing committee.
Disclosure: This article was created by the touchCARDIO team utilizing AI as an editorial tool (ChatGPT (GPT-4o) [Large language model]. https://chat.openai.com/chat.) The content was developed and edited by human editors. No funding was received in the publication of this article.
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