Challenges in Identification of PAD in Health Systems

Manesh Patel, MD:PAD [peripheral artery disease] is prevalent; we know it’s CAD [coronary artery disease] and PAD, and it’s the same process, but why is it? Is it the multilayered specialty problem? One issue is, when you have PAD depending on where you live, you can get sent to see 7 different types of doctors, a vascular surgeon, a vascular medicine specialist, a primary care doctor, a podiatrist, a cardiologist. Why don’t we have a way to truly own this space as a group of physicians? What are your thoughts on that? Amr, I know you think as an interventionist, and you probably see a lot of this.

Amr Abbas, MD:I’m optimistic. Ten or 15 years ago there was a big battle between vascular surgeons and cardiologists. The realization was that the data that came out of the cardiovascular space, in terms of improving outcomes and not just looking to the patient as a limb or a foot, it was very powerful to have these dialogues between the vascular surgeons and us. We have for example, in the structure of our clinic where we have surgeons, cardiologists, nurses, and midlevel providers, we have discussions with patients, to give them the options, alternatives, and evidence-based proof, to make a joint decision. I agree, early on there was a bit of nonclarity about who the patient should see. But as the vascular surgeons got more into the endovascular space, and as we received more data, these dialogues have become more frequent, at least in my practice.

Manesh Patel, MD:Hopefully we’ll have a future state where patients can find whoever can help them, and hopefully it’s a broad group of people.

Larry Allen, MD:I’ve not been that impressed with decision support and automatic systems for identification and triggering of screening, but I’m optimistic that we’re getting to the point where that may be the case. Maybe it won’t come from me and you, maybe it’ll come from Amazon or Google or something.

Manesh Patel, MD:Some evil force out there.

Larry Allen, MD:We’re getting closer to where we’ll have better algorithms and automatic aids to help us identify this population that is out there, and for most of us, is not often being screened. We were chatting before about, all of us care about this topic, we come from different health systems, and none of us are particularly impressed with the ability of our own health system to do a great job at this. There is work to be done, but there’s a lot of opportunity based on technology and other evolution in health care.

Manesh Patel, MD: We’re all learning to be better at organizing ourselves, and I think your point is great.

This transcript has been edited for clarity.