Cited by 2,835Peripheral Artery Disease ManagementDiabetic Foot Ulcer Assessment and ManagementVascular Procedures and Complications

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Peripheral Arterial Disease Detection, Awareness, and Treatment in Primary Care

Hirsch, Alan T.·2001·JAMA

DOI 10.1001/jama.286.11.1317

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Abstract

Context Peripheral arterial disease (PAD) is a manifestation of systemic atherosclerosis that is common and is associated with an increased risk of death and ischemic events, yet may be underdiagnosed in primary care practice. Objective To assess the feasibility of detecting PAD in primary care clinics, patient and physician awareness of PAD, and intensity of risk factor treatment and use of antiplatelet therapies in primary care clinics. Design and setting The PAD Awareness, Risk, and Treatment: New Resources for Survival (PARTNERS) program, a multicenter, cross-sectional study conducted at 27 sites in 25 cities and 350 primary care practices throughout the United States in June-October 1999. Patients A total of 6979 patients aged 70 years or older or aged 50 through 69 years with history of cigarette smoking or diabetes were evaluated by history and by measurement of the ankle-brachial index (ABI). PAD was considered present if the ABI was 0.90 or less, if it was documented in the medical record, or if there was a history of limb revascularization. Cardiovascular disease (CVD) was defined as a history of atherosclerotic coronary, cerebral, or abdominal aortic aneurysmal disease. Main outcome measures Frequency of detection of PAD; physician and patient awareness of PAD diagnosis; treatment intensity in PAD patients compared with treatment of other forms of CVD and with patients without clinical evidence of atherosclerosis. Results PAD was detected in 1865 patients (29%); 82…

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“However, although there is increasing evidence about the paramount importance of early PAD detection and management, it still remains largely underdiagnosed and undertreated, mainly because a lack of awareness concerning the serious morbidity and mortality associated with this atherosclerotic disease [1–4].”
Background
The Arteriomobil Project for peripheral arterial disease.
Pfeiffer, M., Bock, E., Hohenberger, T., & Kröger, K. (2008) · VASA. Zeitschrift fur Gefasskrankheiten · doi:10.1024/0301-1526.37.4.345 · Cited by 7
Management of cardiovascular risk factors by primary care physicians in patients with peripheral arterial disease.
D'Souza, J., Patel, N., Rocker, M., Townsend, E., Morris-Stiff, G., Magee, T., Galland, R. B., & Lewis, M. H. (2008) · The Surgeon · doi:10.1016/s1479-666x(08)80109-6 · Cited by 7
A critical review of antiplatelet treatment in peripheral arterial disease
Violi, F., & Hiatt, W. R. (2007) · Internal and Emergency Medicine · doi:10.1007/s11739-007-0040-z · Cited by 6
“By this approach it became evident that a large number of persons are affected by PAD and have a potentially high risk of atherosclerotic complications [6].”
Background
Prevalence of symptomatic and asymptomatic peripheral arterial disease in primary care patients.
Aboyans, V., Lacroix, P., & Laskar, M. (2004) · Atherosclerosis · doi:10.1016/j.atherosclerosis.2004.02.002 · Cited by 7
Die periphere arterielle Verschlusskrankheit (PAVK)artérielle occlusive périphérique (MAOP)
Cetin, C., & Baumgartner, I. (2004) · doi:10.4414/smf.2004.05128 · Cited by 7
Cardiovascular Health and Healthy Aging
Reynolds, I. J., Page, R. L., II, & Boxer, R. S. (2019) · Springer eBooks · doi:10.1007/978-3-030-06200-2_5 · Cited by 10
Diabetes Mellitus and Peripheral Vascular Disease
Freeby, M. (2012) · Humana Press eBooks · doi:10.1007/978-1-62703-158-5_3 · Cited by 3
Polymers for Biomedical Applications: the Quest for Treating Cardiovascular Diseases
Daele, L. V., Vlierberghe, S. V., & Dubruel, P. (2025) · Advanced Materials · doi:10.1002/adma.202514833 · Cited by 7
Mitochondrial transfer from adipose-derived regenerative cells contributes therapeutic angiogenesis in a murine hindlimb ischemia model
Che, Y., Shimizu, Y., Hayashi, T., Suzuki, J., Pu, Z., Tsuzuki, K., Narita, S., Yura, Y., Shibata, R., & Murohara, T. (2025) · Angiogenesis · doi:10.1007/s10456-025-10001-z · Cited by 9
“Peripheral artery disease (PAD) is an obstructive atheroscle - rotic condition of the lower limbs that affects millions of people worldwide [1, 2].”
Microbiota γ‐Butyrobetaine Is Associated With Increased Risk of Major Adverse Limb Events in People With Lower Extremity Arterial Disease Undergoing Endovascular Therapy
Chen, Z.-W., Wu, W.-K., Chiang, J.-Y., Cheng, N.-C., Lee, J.-K., & Wu, M.-S. (2025) · Journal of the American Heart Association : Cardiovascular and Cerebrovascular Disease · doi:10.1161/jaha.124.037356 · Cited by 6
Cutting-edge European guidelines for managing lower extremity peripheral arterial disease - Featuring selected insights on PAD management.
Buso, G., Hersant, J., Keller, S., Kalaja, I., Bigolin, P., Porceddu, E., Ghirardini, F., Novaković, M., Meilak, D. G., Džupina, A., et al. (2025) · VASA. Zeitschrift fur Gefasskrankheiten · doi:10.1024/0301-1526/a001186 · Cited by 6
Sauna use as a novel management approach for cardiovascular health and peripheral arterial disease
Sastriques-Dunlop, S., Elizondo-Benedetto, S., & Zayed, M. A. (2025) · Frontiers in Cardiovascular Medicine · doi:10.3389/fcvm.2025.1537194 · Cited by 6
“Such strategies are crucial not only for improving cardiovascular morbidity and mortality, but for enhancing limb-related outcomes as well (5, 7).”
The Geographic Distribution of Vascular Surgeons and Trainees by State in 2023.
Henning, N., Nsa, W., Edmonds, J., Nguyen, A. M., Abadi, A., Nelson, P. R., Homco, J., Motta, F., Jennings, W., Zamor, K. C., et al. (2024) · Annals of Vascular Surgery · doi:10.1016/j.avsg.2023.12.062 · Cited by 6
Admixture mapping of peripheral artery disease in a Dominican population reveals a putative risk locus on 2q35
Cullina, S., Wojcik, G. L., Shemirani, R., Klarin, D. M., Gorman, B. R., Sorokin, E. P., Gignoux, C. R., Belbin, G. M., Pyarajan, S., Asgari, S., et al. (2023) · Frontiers in Genetics · doi:10.3389/fgene.2023.1181167 · Cited by 8
“The Peripheral Arterial Disease Awareness Risk and Treatment: New Resources for Survival Study found that only 45% of a cohort with PAD had been diagnosed (Hirsch et al., 2001).”
Implications of Kidney Disease in Patients with Peripheral Arterial Disease and Vascular Calcification.
Mantha, Y., Asif, A., Fath, A. R., & Prasad, A. (2023) · Interventional Cardiology Clinics · doi:10.1016/j.iccl.2023.06.010 · Cited by 6
Acute Coronary Syndrome: Disparities of Pathophysiology and Mortality with and without Peripheral Artery Disease
Gherasie, F.-A., Popescu, M. R., & Bartos, D. (2023) · Journal of Personalized Medicine · doi:10.3390/jpm13060944 · Cited by 8
“A small percentage of patients are diagnosed with intermittent claudication, with either no exertional leg symptoms (up to 50%) or atypical leg symptoms (almost 50%) [13].”
Background
Cognitive Impairment is Common in a Veterans Affairs Population with Peripheral Arterial Disease.
Smith, E. J. T., Gasper, W., Schneider, P. A., Finlayson, E., Walter, L., Covinsky, K. E., Conte, M., & Iannuzzi, J. C. (2022) · Annals of Vascular Surgery · doi:10.1016/j.avsg.2022.11.029 · Cited by 6
Secular trends in the epidemiologic patterns of peripheral artery disease and risk factors in China from 1990 to 2019: Findings from the global burden of disease study 2019
Gong, W., Shen, S.-H., & Shi, X. (2022) · Frontiers in Cardiovascular Medicine · doi:10.3389/fcvm.2022.973592 · Cited by 6
“Although peripheral arterial disease poses a very large and increasing burden and threat to the health care system and society, it remains an underappreciated problem (28, 29).”
Background
Identifying Potentially Avoidable Femoral to Popliteal ePTFE Bypass for Claudication Using Cross Site Blinded Peer Review.
Howard, R., Albright, J., Fleckenstein, R., Forrest, A., Osborne, N., Corriere, M., Seth, M., Laveroni, E., Blebea, J., Mouawad, N. J., et al. (2022) · Journal of Vascular Surgery · doi:10.1016/j.jvs.2022.09.005 · Cited by 6
Distal Bypass Versus Infrageniculate Endovascular Intervention for Chronic Limb-Threatening Ischemia
Kim, Y., DeCarlo, C. S., Thangappan, K., Zacharias, N., Mohapatra, A., & Dua, A. (2022) · Vascular and Endovascular Surgery · doi:10.1177/15385744221086347 · Cited by 6
“Its most severe manifestation is termed chronic limb-threatening ischemia (CLTI), and is manifested through tissue loss and persistent lower extremity rest pain.(2) In addition to chronic disability, CLTI also carries a high risk of amputation(3) and warrants urgent intervention.”
Background
Socioeconomic Characteristics of those with Peripheral Artery Disease in the Chronic Renal Insufficiency Cohort (CRIC)
Stoecker, J., Cohen, J., Belkin, N. L., Chen, J., Townsend, R., Xie, D., Feldman, H., & Wang, G. J. (2022) · Vascular · doi:10.1177/17085381211053492 · Cited by 6
“Peripheral arterial disease (PAD) is a common disease, with an estimated prevalence of approximately 8 million in the United States, and is a major source of morbidity and mortality, resulting in functional impairment, limb loss, as well as death.(3) While low socioeconomic status (SES) has been linked with an increas…”
Background
Effects of Peripheral Arterial Disease Interventions on Survival: A Propensity-Score Matched Analysis Using VQI Data
Mukherjee, D., Liu, C., Jadali, A., Lewis, E., & Neville, R. F. (2021) · Annals of Vascular Surgery · doi:10.1016/j.avsg.2021.08.004 · Cited by 6

Authors: Hirsch, A. T.
Affiliations: University of Minnesota (US)
Corresponding author: Hirsch, Alan T.
Venue: JAMA
Publisher: American Medical Association (AMA)
Published: 2001-09-19
Volume: 286
Issue: 11
Pages: 1317
ISSN: 0002-9955 (ISSN-L)
0098-7484
DOI: 10.1001/jama.286.11.1317
OpenAlex: W2140136269
Cited by: 2,835
References: 0
Citations by year: 2026: 59 · 2025: 77 · 2024: 89 · 2023: 102 · 2022: 113 · 2021: 127 · 2020: 100 · 2019: 105 · 2018: 147 · 2017: 105 · 2016: 135 · 2015: 122 · 2014: 160 · 2013: 145 · 2012: 166
FWCI: 62.22
Type: journal article
Language: en
Open access: closed
Locations: JAMA (publishedVersion)
PubMed (publishedVersion)
Funders: National Institutes of Health (5k07hl003435-05)
National Heart, Lung, and Blood Institute (1-K07-HL03435-01)
Topics: Health Sciences › Medicine › Surgery › Peripheral Artery Disease Management
Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetic Foot Ulcer Assessment and Management
Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Vascular Procedures and Complications
Keywords: peripheral arterial disease, ankle-brachial index, underdiagnosis, patient awareness, physician awareness, cardiovascular disease, atherosclerosis, antiplatelet therapy, smoking cessation, diabetes mellitus, intermittent claudication, primary care, older adults, limb revascularization, cardiovascular risk stratification, diabetes self-management education
MeSH terms: Aged, Arteriosclerosis, Cardiovascular Diseases, Cross-Sectional Studies, Family Practice, Female, Humans, Intermittent Claudication, Health Knowledge, Attitudes, Practice, Male, Middle Aged, Platelet Aggregation Inhibitors, Risk Factors, Ultrasonography, Doppler

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Peripheral Arterial Disease Detection, Awareness, and Treatment in Primary Care

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