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Peripheral arterial disease (PAD) represents atherosclerotic disease in the large-vessel arterial beds excluding the coronary and cerebral circulation. PAD is asymptomatic in 50% of patients which often delays diagnosis. Early recognition can minimize complications such as limb loss and prevent cardiovascular complications, a major cause of morbidity and mortality in these patients. AHA/ACCF guidelines released in 2005 and 2011 have focused on augmenting PAD surveillance. The goal of this study is to evaluate the response to guidelines by measuring new diagnoses of PAD from 2006-2013 at an urban, university medical center.
Medical records of patients newly diagnosed with peripheral arterial disease from 2006-2013 were evaluated under the premise of intuitional IRB. There were no exclusion criteria. Patient age, gender, and ethnicity were obtained. An anonymous database which maintained patient confidentiality was created with new diagnoses of PAD grouped by their respective months and years.
Medical records of 758,927 patients were surveyed for the diagnosis of PAD. The total patients seen increased annually, from 74,666 patients in 2006 to 126,683 patients in 2013. Average age of the patient population increased (47.234 years-49.374 years) over the eight year period. 5,242 patients (2628 males, 2614 females) were diagnosed with PAD. The incidence of PAD increased from 2006-2009 (0.00715-0.00860) and decreased from 2009-2013 (0.00860-0.00429). The average age at diagnosis did not follow a linear trend but increased from 65.227 years to 69.864 years from 2009-2013.
Individuals with peripheral arterial disease (PAD) have higher morbidity and mortality due to cardiovascular causes. This study is of interest because despite a growing, aging patient population and a recommended earlier age of surveillance, the findings show an overall decline in incidence of PAD and an increasing age at diagnosis from 2006-2013. Suspected lack of guideline awareness, dearth of primary care literature about PAD, and insufficient diagnostic experience among primary care physicians may explain these findings. Further research about guideline efficacy and physician awareness of PAD should be performed.