OSU Peripheral Arterial Disease (PAD) Screening Tool

Why Clinicians Ought to Consider a Screening Tool For Peripheral Arterial Disease (PAD)?

Screening for PAD is crucial for early diagnosis, reducing cardiovascular events, preventing limb loss, and improving overall patient outcomes.

1. Early Detection and Prevention of Severe Complications

• PAD is often asymptomatic in its early stages but can progress to critical limb ischemia, increasing the risk of ulcers, gangrene, and amputation.
• Early diagnosis allows for timely interventions to prevent disease progression and severe outcomes.

2. Indicator of Systemic Atherosclerosis and Cardiovascular Risk

• PAD is a strong marker of generalized atherosclerosis and is associated with an increased risk of myocardial infarction, stroke, and cardiovascular death.
• Screening helps identify patients at high cardiovascular risk, leading to early initiation of preventive strategies.

3. Improved Management and Treatment Outcomes

• Early detection allows for lifestyle modifications (smoking cessation, supervised exercise therapy) and medical management (antiplatelet therapy, hyperlipidemia treatment, antihypertensives, etc.) to slow disease progression.
• Proper management reduces symptoms such as intermittent claudication and improves mobility and quality of life.

4. Cost-Effective Prevention Strategy

• Detecting PAD early reduces the economic burden associated with advanced disease treatment, including hospitalizations, surgical interventions, and amputations.

5. Targeted Screening for High-Risk Groups

• Individuals with diabetes, smoking history, hypertension, hyperlipidemia, and those aged 65+ are at higher risk and benefit most from screening.

App Components

The OSU PAD Screening app incorporates several assessment modalities to assist the clinician in detecting the presence of PAD.

1. ABPI calculator & diagnostic recommendations

2. High risk limb presentation screen

3. Quality of Life Survey (VASCUQOL-6)

4. Antithrombotic medication management strategies for asymptomatic PAD, symptomatic PAD & PAD post revascularization (AC Forum Rapid Resources)

5. Risk factor and risk amplifying conditions screening

6. Risk reduction strategies

Why Include Symptom-based Assessments?

According to Bonaca et al. (2020), limb symptoms frequently develop in patients with peripheral artery disease, to include those that are post revascularization. Such symptoms range from severe claudication, which limits function, to critical limb-threatening ischemia. Patients who undergo peripheral revascularization are at high risk for subsequent vascular complications with a risk approximately 4 times as high as that among persons who have never undergone revascularization. 

Why Include Medication Management Strategies?

Studies indicate medication use can decrease the rates of Major Adverse Limb Events (MALE) and/or Major Adverse Cardiovascular Events (MACE). The Cardiovascular Outcomes for People Using Anticoagulation Strategies (COMPASS) trial showed that rivaroxaban (a selective direct factor Xa inhibitor) at a dose of 2.5 mg twice daily added to aspirin reduced ischemic risk (MACE and MALE) as compared to aspirin alone. Additional factors, such as bleeding risk, also play a role in the judicial use of anticoagulants. Medication treatment plans in the presence of bleeding risk factors will require additional scrutiny as the clinician and patient weigh the risks versus benefits. 

This app also intentionally evaluates for barriers to care, including medication access, assessment of social determinants of health, and identification of populations with known health disparities in PAD identification and treatment.

The medication management decision support used in this app was developed by the Anticoagulation Forum (Barnes, Parikh & Wirth, 2021) as an ACE Rapid Resource, called the Antithrombotic Management Following Peripheral Arterial Disease (PAD) Revascularization. The following disclaimer is posted by the AC Forum, "ACE Rapid Resources are not clinical practice guidelines; they are Anticoagulation Forum, Inc.’s best recommendations based on current knowledge, and no warranty or guaranty is expressed or implied. The content provided is for informational purposes for medical professionals only and is not intended to be used or relied upon by them as specific medical advice, diagnosis, or treatment, the determination of which remains the responsibility of the medical professionals for their patients."

App Logic

To learn how the app logic works, you can inspect the app builder or refer to the PAD App Logic Map.

• Routine ABI screening for those not at increased risk of PAD is not recommended
• Patients at increased risk for PAD:
  • Age >64
  • Age 50-64 plus risk factors for atherosclerosis (eg, diabetes, history of smoking, dyslipidemia, hypertension), chronic kidney disease, or familyhistory of PAD
  • Age <50 plus diabetes and 1 additional risk factor for atherosclerosis