Choosing Wisely NL. Peripheral Artery Disease
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1 Choosing Wisely NL Peripheral Artery Disease
2 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. There are simple and safe ways to improve PAD symptoms through home management. Choosing Wisely Canada guideline: Do not suggest a test that will not change the patient s clinical course. Do peripheral vascular testing in those who could potentially benefit from a revascularization procedure.
3 Who needs a test? Refer patients for peripheral vascular testing if they have any of the following: Rest pain: Pain in feet, especially when legs are elevated in bed Extremity ulcer: Sores on toes or feet that won't heal Gangrene: Toe that looks blue or black and may hurt Severe Claudication: Leg pain during exercise severe enough to limit lifestyle or ability to work
4 Who needs a test and who doesn t? Only refer patients with Good Indicators for PAD testing: Good 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 or work) Poor Indicators 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
5 What s happening in Newfoundland? Percentage of testing by indication (St. Clare s , N = ) Percentage of tests 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Follow up post revascularization 11% Inappropriate / no symptoms 49% Appropriate symptoms, test indicated 40% Test indication
6 What s happening in Newfoundland? Over 2500 PAD tests are conducted each year at St. Clare s Vascular Lab 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
7 What s happening in NL? Proportion of tests analyzed by indication and by presence of PVD: (excluding testing in patients with a previous limb revascularization procedure) Number of tests Severe Moderate Mild Normal Indicated Moderate Mild Normal Not indicated Severe Volume of tests at St. Clare s ( ) Indicated 1983 (28%) Not indicated Normal Mild Moderate Severe Total 7493 (84%) 1543 (22%) 718 (8%) 2194 (32%) 527 (6%) 1238 (18%) 162 (<2%) 6958 (44% total tests) 8900 (56% total tests) 15858
8 How can we improve? 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.
9 What you can do 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 Blood include: Pressure control (with ACE) Quitting smoking Proper foot care Regular exercise (walk daily) Cholesterol control (with Statin) Aspirin and/or Plavix Diabetic management
10 Tools to help your practice Contact Choosing Wisely NL at choosingwiselynl.ca for printed copies of pamphlets or prescription pads to be mailed to your practice Download printer friendly copies of the patient pamphlet and prescription pad and view our video at the links below OR Patient Pamphlet: Blocked Leg Arteries - CWNL Prescription Pad: Blocked Leg Arteries - CWNL Video: Blocked Leg Arteries - CWNL
11 Personal data Click the PDF link below¹ to access aggregate data for Peripheral Artery testing at St Clare s Mercy Hospital from 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.
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