Peripheral Artery Disease Screening in the Community and 1-Year Mortality, Cardiovascular Events, and Adverse Limb Events
Open accessAbstract
Introduction: This study aimed to examine all-cause mortality, 1- and 2-year major cardiovascular events, and major adverse limb events in individuals aged ≥65 years who received an in-home health visit with peripheral artery disease screening. In addition, we compared 1-year healthcare utilization before and after peripheral artery disease screening for those who screened positive. Setting/Participants: Medicare Advantage beneficiaries aged ≥65 years participating in the Optum HouseCalls program in the U.S. between April 1, 2017 and February 1, 2019 were included. Intervention: The intervention consisted of a peripheral artery disease screening program using a plethysmography system. Main outcome measures: One-year all-cause mortality as a landmark analysis, 1- and 2-year major cardiovascular events, and major adverse limb events after screening were compared by peripheral artery disease screen status using claims data. We compared cardiovascular medications and revascularization procedures between the year before and after the peripheral artery disease screening event for those with peripheral artery disease. Results: <0.001; adjusted hazard ratio=1.21; 95% CI=1.08, 1.36) as well as 1-year major cardiovascular events (5.54% vs 3.60%; adjusted hazard ratio= 1.22; 95% CI=1.15, 1.30) and major adverse limb events (0.23% vs 0.04%; adjusted hazard ratio=3.15; 95% CI=2.10, 4.73). Similar risks were observed for 2-year results. Before and after peripheral artery disease screening, medications remained stable for those who screened positive (e.g., statin therapy=54.2% vs 56.6%); rates of peripheral vascular interventions remained stable (0.0% vs 0.1%). Conclusions: A national peripheral artery disease screening effort is feasible. Detecting previously undiagnosed peripheral artery disease is a way to risk stratify a population that would benefit from further cardiovascular risk management.
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A positive screening test for PAD in an asymptomatic population has been associated with increased cardiovascular event rates.
“While a positive screening test for PAD in an asymptomatic population has been associated with increased cardiovascular event rates (241,242), prospective, randomized studies addressing whether screening for PAD in people with diabetes improves longterm limb outcomes and cardiovascular event rates are limited.”
From 10. Cardiovascular Disease and Risk Management: Standards of Care in Diabetes—2025 (2025) · cites this paper as [241]
The Results report higher 1-year major adverse cardiovascular event rates after a positive PAD screen than after a negative screen (5.54% versus 3.60%). The Discussion describes participants as previously unknown to have PAD, but does not establish that the screened population was asymptomatic; that qualifier is not supported. (LLM, conf=0.84)
Experimental — accuracy not yet measuredA positive screening test for PAD in an asymptomatic population has been associated with increased cardiovascular event rates.
“While a positive screening test for PAD in an asymptomatic population has been associated with increased cardiovascular event rates (230,231), prospective, randomized studies addressing whether screening for PAD in”
From 10. Cardiovascular Disease and Risk Management: Standards of Care in Diabetes—2026 (2026) · cites this paper as [230]
The Results report higher major adverse cardiovascular event rates after a positive PAD screen than after a negative screen. The Discussion describes participants as previously unknown to have PAD, but does not establish that the screened population was asymptomatic; that qualifier is not supported. (LLM, conf=0.85)
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- Authors
- Smolderen, K. G., Ameli, O., Chaisson, C. E., Heath, K., & Mena-Hurtado, C.
- Affiliations
- Yale University (US)
- Optum (United States) (US)
- Corresponding author
- Smolderen, Kim G.
- Venue
- AJPM Focus
- Publisher
- Elsevier BV
- Published
- 2022-09
- Volume
- 1
- Issue
- 1
- Pages
- 100016
- ISSN
- 2773-0654 (ISSN-L)
- PMC
- PMC10546509
- OpenAlex
- W4288046001
- Cited by
- 11
- References
- 34
- Citations by year
- 2026: 3 · 2025: 3 · 2024: 3 · 2023: 2
- FWCI
- 1.91
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- AJPM Focus (publishedVersion, cc-by-nc-nd)
- PubMed Central (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- UnitedHealth Group Inc
- Topics
- Health Sciences › Medicine › Surgery › Peripheral Artery Disease Management
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Health Promotion and Cardiovascular Prevention
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Vascular Procedures and Complications
- Keywords
- peripheral arterial disease, screening, all-cause mortality, major cardiovascular events, major adverse limb events, plethysmography, Medicare Advantage beneficiaries, older adults, cardiovascular risk stratification, health care utilization, revascularization
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