I attended a podiatry lecture last week. It was a sponsored dinner put out by one of the makers of a rotorooter device for clogged arteries. The first speaker was a podiatrist who was informing his audience how not enough PAD testing was being performed.
He went on and on how the American Diabetes Association recommends that every diabetic over 50 have one of these exams and the speaker went on to inform the audience how "its good practice management as well".
He continued to let us know it should be done every 6 months and it is paid for both times.
Tonight, I stumbled across an article/blog how the U.S. Preventative Services Task Force released findings back in Sept that "it's unclear whether using the ankle brachial index to screen for PAD and assess the risk for heart disease is beneficial in people with no symptoms".
The American heart Association states PAD becomes more common with age, often goes undiagnosed and people who have it have a 4-5 times more risk of heart attack or storke.
A Dr. McDermott was quoted as saying "there is not high qualilty evidence to demonstrate that screening for PAD with ABI's reduces cardiovascular event rates".
The article which was from a site or blog called "Healthday" states PAD is usually treated with blood pressure medications and cholesterol lowering drugs.
I have many questions after reading this:
1) I don't know anyone that treats PAD of the lower extremity at least with blood pressure medications or cholesterol lowering medications. To me, blood pressure reducing medications are given to people who have high blood pressure not to anyone with a low ankle arm index. Similiarly, cholesterol lowering agents are given to people who have high cholesterol analyzed in blood work not from an ankle arm index.
2) What exactly is the correlation with PAD and heart disease? Whenever, I. personally send a patient for a vascular consult SHOULD I also be sending him for a cardiology consult? Should the vascular doctor be checking heart function as well as lower extremity function?
3) Ever look at Medicare guidelines for when performing ABI's are reimburseable? At the point where they are the patient is likely at a higher risk and at that time needs an MRA not a non invasive test.
4) Perhaps the reason why many cases are undiagnosed is because patients may be neuropathic or the early stages are not painful? In which case screening is a good idea.
5) The speaker of my dinner likely should have his ABI equipment revoked. I think every diabetic over 50 twice a year testing is a bit much. This overindulgent type of practice is what got us into this Obamacare mess to begin with. Some sense of honesty and ethical behavior is mandated. (Okay, lets not revoke his equipment, let his equipment not enable him to furnish a bill twice ayear only once....unless medical hx changes.)
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