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The Next Step in Peripheral Arterial Disease Public Awareness
Commentary
The Next Step in Peripheral Arterial Disease Public Awareness Janette D. Durham, MD, MBA, Michael D. Darcy, MD, and Tricia E. McClenny J Vasc Interv Radiol 2004; 15:667– 668 Abbreviation:
PAD ⫽ peripheral arterial disease
IN an editorial in this issue of JVIR, Hirsch and coauthors (1) report the outcome of a 2-day Peripheral Arterial Disease (PAD) Public Education Strategy Meeting held in January of 2003. This meeting, organized by the Vascular Disease Foundation and hosted by the National Heart, Lung, and Blood Institute, was preceded by the Society of Interventional Radiology (SIR)– sponsored Peripheral Vascular Health Summit in August of 2002. SIR initiated and hosted the Peripheral Vascular Health Summit 2002 to address several issues. It was recognized that there was a compelling need for increased public education regarding PAD and peripheral vascular disease, and it was believed that a unified effort would be more successful and more cost-effective than multiple smaller competing programs and efforts. The SIR also recognized that, although Legs For Life® was quite successful, it had grown to the point at which SIR would have difficulty sustaining the effort to further increase awareness with its resources alone. A
From the Mallinckrodt Institute of Radiology (M.D.D.), Washington University School of Medicine, St. Louis, Missouri; Department of Radiology (J.D.D.), University of Colorado Heath Sciences Center, 4200 East Ninth Avenue, A030, Denver, Colorado 80262; and Society of Interventional Radiology (T.E.M.), Fairfax, Virginia. Received April 13, 2004; accepted April 13. Address correspondence to J.D.D.; E-mail: [email protected] None of the authors have identified a conflict of interest. © SIR, 2004 DOI: 10.1097/01.RVI.0000129463.99317.B0
greater long-term sustained nationwide educational effort was needed to create the impact proven possible by other national campaigns. The 2002 Peripheral Vascular Health Summit brought together for the first time the nation’s leading medical organizations, advocacy groups, and government agencies to address these issues. The 17 organizations attending the 2-day Summit began the first stages of developing a framework for a collaborative approach toward public education, public awareness, and improved detection of peripheral vascular disease and abdominal aortic aneurysm (see Appendix). The Secretary of Health and Human Services was impressed with this effort, and Assistant Secretary of Health and Human Services, Eve Slater, MD, made an address early in the meeting encouraging the group to speak with one voice. The Summit concluded with the commitment of all present to proceed with a PAD public awareness campaign under the direction of an organization that would have representation from all specialties interested in vascular disease. Becker et al (2), in a 2002 JVIR commentary, defended the position for such a campaign based on scientific data that confirm the cardiovascular risk present in patients with PAD. Analysis of 3-year benchmark consumer survey data on awareness of peripheral vascular disease from the Legs For Life® screening and awareness program indicated that patients had a similar level of awareness as primary care physicians and that it could be greatly increased. Becker et al
(2) called for a consistent and uniform message to primary care providers and to the public with the goal of reducing cardiovascular risk. He concluded that this would be best accomplished by working “in harmony with other medical specialties representing health care professionals who treat the disease, organizations representing patients at risk, private philanthropies, nonprofit and public entities, and with all parties having an express interest in the field.” In their article, Hirsch et al (1) echo many of these same arguments. SIR has had a long history of supporting PAD public awareness. Legs For Life®, a program dedicated to improving the cardiovascular health of the community, was devised in 1998 and launched nationally in September 1999 with three primary goals: to educate the public and medical community regarding PAD, to provide for early detection when appropriate, and to strengthen collaborative relationships among health care professionals. This program, now in its sixth year, was evaluated by an independent health research firm, which concluded that the program met its proposed goals (3). Eighty percent of the surveyed participants identified the ankle-brachial index given during the screening program and half reported that leg pain when walking was a symptom of PAD. In addition, just fewer than half were able to identify individuals at the highest risk for the disease, and a majority of respondents could identify ways to prevent or slow progression of the disease. This program has grown into the
667
668
•
July 2004
Commentary: The Next Step in PAD Public Awareness
largest, most inclusive, and most comprehensive national society-run program for vascular disease screening. More than 300,000 individuals have been screened by more than 28,000 health care professionals. Three to four hundred sites participate annually with collaborating teams of interventional radiologists, cardiologists, vascular surgeons, podiatrists, radiology nurses, vascular nurses, technologists, medical students, and other volunteers. National and local media coverage is estimated to have generated 1.3 billion audience impressions. The program has been expanded to include abdominal aortic aneurysm, carotid/stroke, and venous disease screening in addition to PAD. The program is also expanding globally, with screenings in Australia and India and initiatives starting in Asia. The Legs For Life® Committee members have been the champions of this initiative. Supporting organizations have been valuable to the program’s success as well. They include the American Diabetes Association, American Radiological Nurses Association, the Council on Cardiovascular Radiology and Intervention of the American Heart Association, and the Society for Vascular Nursing. Despite the unquestionable success of Legs For Life®, several large surveys suggest that patients and their primary care physicians remain uninformed of the cardiovascular risk implication of PAD and that only 25% of patients with PAD undergo treatment (4,5). Recognizing the mismatch between the population affected by Legs For Life® and the population at risk (10 million), it is obvious that an extended approach is needed. The Vascular Disease Foundation is building on the consensus of the multidisciplinary group that convened in August 2002. This coalition is currently composed of 17 professional societies and public health associations whose missions support the preven-
tion, diagnosis, treatment, and rehabilitation of vascular diseases. Working with the National Heart, Lung, and Blood Institute at the PAD Public Education Strategy Meeting, members of the coalition were able to create a set of science-based PAD messages that could be disseminated to Americans at risk of disease. In addition, the participants were educated in what next steps would be required to implement such a campaign based on similar past campaigns. The Vascular Disease Foundation has committed to guiding this new coalition, a job that includes the creation of an organizational framework, an action plan, a time line, and, most importantly, a mechanism for funding. The SIR leadership supports a public awareness campaign that builds on past success and expands its reach. We are pleased that the important public health goals that were developed during the 2002 Peripheral Vascular Health Summit are continuing to be pursued. We have long recognized the need for a broad coalition of public organizations and federal agencies that work collaboratively to create a uniform, public-focused message. And we are ready to take the next step.
APPENDIX: PERIPHERAL VASCULAR HEALTH SUMMIT 2002 ATTENDEES American Association for Vascular Surgery American College of Cardiology American Diabetes Association American Heart Association American Podiatric Medical Association American Radiological Nurses Association American Society of Interventional and Therapeutic Neuroradiology American Vascular Association National Institutes of Health–National Heart, Lung and Blood Institute National Institutes of Health–Na-
JVIR
tional Institute of Neurological Disorders Peripheral Vascular Surgery Society Society for Vascular Medicine and Biology Society for Vascular Nursing Society for Vascular Surgery Society of Interventional Radiology Vascular Disease Foundation U.S. Department of Health and Human Services: Assistant Secretary of Health Eve Slater, MD Industry Participants Abbott Laboratories Boston Scientific Cook Incorporated Cordis Endovascular Guidant Corporation References 1. Hirsch AT, Gloviczki P, Drooz A, Lovell M, Creager MA, for the Board of Directors of the Vascular Disease Foundation. Mandate for creation of a national peripheral arterial disease public awareness program: an opportunity to improve cardiovascular health. J Vasc Interv Radiol 2004; 15:671– 679. 2. Becker GJ, McClenny TE, Kovacs ME, Raabe RD, Katzen BT. The importance of increasing public and physician awareness of peripheral arterial disease. J Vasc Interv Radiol 2002; 13:7–11. 3. Johnsen MC, Landow WJ, Sonnefeld J, McClenny TE, Beatty PT, Raabe RD. Evaluation of Legs For Life® National Screening and Awareness Program for Peripheral Vascular Disease: results of a follow-up survey of screening participants. J Vasc Interv Radiol 2002; 13:25– 35. 4. Awareness of Peripheral Vascular Disease. Caravan Survey conducted by Opinion Research Corporation International for the Society of Cardiovascular and Interventional Radiology, August 1999. Fairfax, VA: SCVIR, 1999. 5. Peripheral Arterial Disease (PAD) Study. Survey conducted by Taylor Nelson Sofrees Intersearch, July 2001. Washington, DC: National Council on the Aging, 2001.
The Next Step in Peripheral Arterial Disease Public Awareness Janette D. Durham, MD, MBA, Michael D. Darcy, MD, and Tricia E. McClenny J Vasc Interv Radiol 2004; 15:667– 668 Abbreviation:
PAD ⫽ peripheral arterial disease
IN an editorial in this issue of JVIR, Hirsch and coauthors (1) report the outcome of a 2-day Peripheral Arterial Disease (PAD) Public Education Strategy Meeting held in January of 2003. This meeting, organized by the Vascular Disease Foundation and hosted by the National Heart, Lung, and Blood Institute, was preceded by the Society of Interventional Radiology (SIR)– sponsored Peripheral Vascular Health Summit in August of 2002. SIR initiated and hosted the Peripheral Vascular Health Summit 2002 to address several issues. It was recognized that there was a compelling need for increased public education regarding PAD and peripheral vascular disease, and it was believed that a unified effort would be more successful and more cost-effective than multiple smaller competing programs and efforts. The SIR also recognized that, although Legs For Life® was quite successful, it had grown to the point at which SIR would have difficulty sustaining the effort to further increase awareness with its resources alone. A
From the Mallinckrodt Institute of Radiology (M.D.D.), Washington University School of Medicine, St. Louis, Missouri; Department of Radiology (J.D.D.), University of Colorado Heath Sciences Center, 4200 East Ninth Avenue, A030, Denver, Colorado 80262; and Society of Interventional Radiology (T.E.M.), Fairfax, Virginia. Received April 13, 2004; accepted April 13. Address correspondence to J.D.D.; E-mail: [email protected] None of the authors have identified a conflict of interest. © SIR, 2004 DOI: 10.1097/01.RVI.0000129463.99317.B0
greater long-term sustained nationwide educational effort was needed to create the impact proven possible by other national campaigns. The 2002 Peripheral Vascular Health Summit brought together for the first time the nation’s leading medical organizations, advocacy groups, and government agencies to address these issues. The 17 organizations attending the 2-day Summit began the first stages of developing a framework for a collaborative approach toward public education, public awareness, and improved detection of peripheral vascular disease and abdominal aortic aneurysm (see Appendix). The Secretary of Health and Human Services was impressed with this effort, and Assistant Secretary of Health and Human Services, Eve Slater, MD, made an address early in the meeting encouraging the group to speak with one voice. The Summit concluded with the commitment of all present to proceed with a PAD public awareness campaign under the direction of an organization that would have representation from all specialties interested in vascular disease. Becker et al (2), in a 2002 JVIR commentary, defended the position for such a campaign based on scientific data that confirm the cardiovascular risk present in patients with PAD. Analysis of 3-year benchmark consumer survey data on awareness of peripheral vascular disease from the Legs For Life® screening and awareness program indicated that patients had a similar level of awareness as primary care physicians and that it could be greatly increased. Becker et al
(2) called for a consistent and uniform message to primary care providers and to the public with the goal of reducing cardiovascular risk. He concluded that this would be best accomplished by working “in harmony with other medical specialties representing health care professionals who treat the disease, organizations representing patients at risk, private philanthropies, nonprofit and public entities, and with all parties having an express interest in the field.” In their article, Hirsch et al (1) echo many of these same arguments. SIR has had a long history of supporting PAD public awareness. Legs For Life®, a program dedicated to improving the cardiovascular health of the community, was devised in 1998 and launched nationally in September 1999 with three primary goals: to educate the public and medical community regarding PAD, to provide for early detection when appropriate, and to strengthen collaborative relationships among health care professionals. This program, now in its sixth year, was evaluated by an independent health research firm, which concluded that the program met its proposed goals (3). Eighty percent of the surveyed participants identified the ankle-brachial index given during the screening program and half reported that leg pain when walking was a symptom of PAD. In addition, just fewer than half were able to identify individuals at the highest risk for the disease, and a majority of respondents could identify ways to prevent or slow progression of the disease. This program has grown into the
667
668
•
July 2004
Commentary: The Next Step in PAD Public Awareness
largest, most inclusive, and most comprehensive national society-run program for vascular disease screening. More than 300,000 individuals have been screened by more than 28,000 health care professionals. Three to four hundred sites participate annually with collaborating teams of interventional radiologists, cardiologists, vascular surgeons, podiatrists, radiology nurses, vascular nurses, technologists, medical students, and other volunteers. National and local media coverage is estimated to have generated 1.3 billion audience impressions. The program has been expanded to include abdominal aortic aneurysm, carotid/stroke, and venous disease screening in addition to PAD. The program is also expanding globally, with screenings in Australia and India and initiatives starting in Asia. The Legs For Life® Committee members have been the champions of this initiative. Supporting organizations have been valuable to the program’s success as well. They include the American Diabetes Association, American Radiological Nurses Association, the Council on Cardiovascular Radiology and Intervention of the American Heart Association, and the Society for Vascular Nursing. Despite the unquestionable success of Legs For Life®, several large surveys suggest that patients and their primary care physicians remain uninformed of the cardiovascular risk implication of PAD and that only 25% of patients with PAD undergo treatment (4,5). Recognizing the mismatch between the population affected by Legs For Life® and the population at risk (10 million), it is obvious that an extended approach is needed. The Vascular Disease Foundation is building on the consensus of the multidisciplinary group that convened in August 2002. This coalition is currently composed of 17 professional societies and public health associations whose missions support the preven-
tion, diagnosis, treatment, and rehabilitation of vascular diseases. Working with the National Heart, Lung, and Blood Institute at the PAD Public Education Strategy Meeting, members of the coalition were able to create a set of science-based PAD messages that could be disseminated to Americans at risk of disease. In addition, the participants were educated in what next steps would be required to implement such a campaign based on similar past campaigns. The Vascular Disease Foundation has committed to guiding this new coalition, a job that includes the creation of an organizational framework, an action plan, a time line, and, most importantly, a mechanism for funding. The SIR leadership supports a public awareness campaign that builds on past success and expands its reach. We are pleased that the important public health goals that were developed during the 2002 Peripheral Vascular Health Summit are continuing to be pursued. We have long recognized the need for a broad coalition of public organizations and federal agencies that work collaboratively to create a uniform, public-focused message. And we are ready to take the next step.
APPENDIX: PERIPHERAL VASCULAR HEALTH SUMMIT 2002 ATTENDEES American Association for Vascular Surgery American College of Cardiology American Diabetes Association American Heart Association American Podiatric Medical Association American Radiological Nurses Association American Society of Interventional and Therapeutic Neuroradiology American Vascular Association National Institutes of Health–National Heart, Lung and Blood Institute National Institutes of Health–Na-
JVIR
tional Institute of Neurological Disorders Peripheral Vascular Surgery Society Society for Vascular Medicine and Biology Society for Vascular Nursing Society for Vascular Surgery Society of Interventional Radiology Vascular Disease Foundation U.S. Department of Health and Human Services: Assistant Secretary of Health Eve Slater, MD Industry Participants Abbott Laboratories Boston Scientific Cook Incorporated Cordis Endovascular Guidant Corporation References 1. Hirsch AT, Gloviczki P, Drooz A, Lovell M, Creager MA, for the Board of Directors of the Vascular Disease Foundation. Mandate for creation of a national peripheral arterial disease public awareness program: an opportunity to improve cardiovascular health. J Vasc Interv Radiol 2004; 15:671– 679. 2. Becker GJ, McClenny TE, Kovacs ME, Raabe RD, Katzen BT. The importance of increasing public and physician awareness of peripheral arterial disease. J Vasc Interv Radiol 2002; 13:7–11. 3. Johnsen MC, Landow WJ, Sonnefeld J, McClenny TE, Beatty PT, Raabe RD. Evaluation of Legs For Life® National Screening and Awareness Program for Peripheral Vascular Disease: results of a follow-up survey of screening participants. J Vasc Interv Radiol 2002; 13:25– 35. 4. Awareness of Peripheral Vascular Disease. Caravan Survey conducted by Opinion Research Corporation International for the Society of Cardiovascular and Interventional Radiology, August 1999. Fairfax, VA: SCVIR, 1999. 5. Peripheral Arterial Disease (PAD) Study. Survey conducted by Taylor Nelson Sofrees Intersearch, July 2001. Washington, DC: National Council on the Aging, 2001.