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American Heart Association Recommends Actions to Reduce Lower Extremity Amputations

Cardi-OH

 

A recent American Heart Association (AHA) policy statement addresses the urgent need to reduce non-traumatic lower extremity amputation, a terrible complication of peripheral artery disease (PAD) that predominantly affects people with diabetes. The policy statement outlines the impacts of non-traumatic lower extremity amputation on patients and the healthcare system, reviews diagnosis and management of PAD, and calls for organizational and policy changes to address both PAD and amputation rates.

Nontraumatic lower-extremity amputations are associated with high mortality and medical expenditure. After a period of substantial decline between 2000 and 2009 in the U.S., the amputation rate increased by 50% from 2009 to 2015 among patients with diabetes. The AHA aims to decrease national rates by 20% by 2030 through the implementation of its recommendations and proposed policies.

Peripheral artery disease is a contributor to critical limb ischemia and subsequent amputation. Several key risk factors, such as smoking, foot ulcers, and hypertension, are modifiable with evidence-based treatments. However, substantial gaps in evidence-based treatment implementation were noted: statins were prescribed for approximately 30% of patients with PAD and smoking cessation was offered only to approximately 35%. The AHA statement also highlights disparities in PAD and amputation rates, and notes that, “[i]mproving the management of PAD could have a significant impact on health care disparities among some racial and ethnic groups and those who are living in poverty.”

Increased awareness is needed among patients and clinicians as to the risks for and treatment of PAD in order to reduce amputation rates. The statement also calls for legislative policies to ensure equitable access to care, prescription affordability for PAD and diabetes patients, and coverage of comprehensive tobacco cessation therapies.

Cardi-OH’s evidence-based resources on smoking cessation, hypertension, and diabetes are available to assist clinicians and teams in diagnosis and management of PAD-associated risk conditions.


  1. Creager MA, Matsushita K, Arya S, et al. Reducing nontraumatic lower-extremity amputations by 20% by 2030: time to get to our feet: a policy statement from the American Heart Association. Circulation. Published online 2021. https://doi.org/10.1161/CIR.0000000000000967.
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