Choosing Wisely NL Peripheral Artery Disease Practice Points - - PowerPoint PPT Presentation
Choosing Wisely NL Peripheral Artery Disease Practice Points Approximately 12% of adults in Newfoundland and Labrador have Peripheral Artery Disease (PAD). Usually, patients with PAD DO NOT need a test or revascularization procedure.
have Peripheral Artery Disease (PAD).
revascularization procedure.
through home management.
that will not change the patient’s clinical course.
potentially benefit from a revascularization procedure.
elevated in bed
heal
hurt
severe enough to limit lifestyle or ability to work
Refer patients for peripheral vascular testing if they have any of the following:
Only refer patients with “Good Indicators” for PAD testing: Good Indicators Poor Indicators
Rest Pain (pain in feet, especially when legs are elevated in bed) Tissue Loss (ulcers/sores on the feet that will not heal or a toe that is blue or black and may hurt) Severe Claudication (leg pain while walking severe enough to limit lifestyle
Mild claudication (mild leg pain during exercise that stops when at rest) Leg cramps Raynaud's Digital cyanosis Absent peripheral pulses Family history with no symptoms
Percentage of testing by indication (St. Clare’s 2007-2015, N = 17 683)
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Test indication
Percentage of tests Inappropriate / no symptoms 49% Follow up post revascularization 11% Appropriate symptoms, test indicated 40%
Over 2500 PAD tests are conducted each year at
Over 90% of the people tested do not need a revascularization procedure
51% Normal Test Result 41% Early signs of PAD 8% May need a procedure
Proportion of tests analyzed by indication and by presence of PVD:
(excluding testing in patients with a previous limb revascularization procedure)
Normal Mild Moderate Severe Total Indicated
1983 (28%) 1543 (22%) 2194 (32%) 1238 (18%)
6958 (44% total tests) Not indicated
7493 (84%) 718 (8%) 527 (6%) 162 (<2%)
8900 (56% total tests) 15858
Normal Normal Mild Mild Moderate
Moderate
Severe
Severe 1000 2000 3000 4000 5000 6000 7000 8000 9000
Indicated Not indicated Number of tests Volume of tests at St. Clare’s (2007-2015)
Our objective is to test patients with symptoms of vascular disease that may need revascularization quickly, and not test patients unless they have symptoms indicative of disease requiring surgical intervention. Unnecessary tests increase wait times for all patients.
For patients with symptoms of mild to moderate PAD, a home management plan is the best way to manage and reduce symptoms. Discuss lifestyle options with these patients and provide them with a pamphlet.
Home management plans may include:
Quitting smoking Regular exercise (walk daily) Aspirin and/or Plavix Diabetic management Blood Pressure control (with ACE) Proper foot care Cholesterol control (with Statin)
Patient Pamphlet: Blocked Leg Arteries - CWNL
Contact Choosing Wisely NL at choosingwiselynl.ca for printed copies of pamphlets or prescription pads to be mailed to your practice OR Download printer friendly copies of the patient pamphlet and prescription pad and view our video at the links below… Video: Blocked Leg Arteries - CWNL Prescription Pad: Blocked Leg Arteries
Click the PDF link below¹ to access aggregate data for Peripheral Artery testing at St Clare’s Mercy Hospital from 2007-2015 and analysis of your personal practice² by indication and by diagnosis of peripheral artery disease.
¹ Not every physician will have personal data available due to limitations in data entry, duration of practice, and volume of referrals. ² Personal data is anonymous and only data on your own personal utilization will be provided to you.