New virtual learning hub underscores importance of patient-centered care in PAD and CAD
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The Foundation to Advance Vascular Cures has launched a new virtual educational resource directed at medical professionals and students who are interested in approaching vascular care with a patient-centric approach.
The PAD/CAD Virtual Learning Hub — freely available online and as a mobile app — features modules centered on peripheral artery disease and CAD. This educational resource aims to be a “first touchpoint” for medical professionals and students to brush up on the intertwined conditions, which can quietly build up in patients before resulting in infection, amputation and, often, earlier death, Isabel Bjork, JD, MS, CEO of Vascular Cures, told Healio.
“We think it’s a critical resource for nonspecialists,” Bjork said. “This is a deep learning hub that has an enormous amount of material.”
The hub utilizes a multimedia approach with modules from leaders and new entrants to the field explaining the conditions and how they should be treated. It includes case studies of varying severity, as well as a video series offering insights from specialists in the field. A departure from traditional resources, the PAD/CAD Learning Hub focuses on patient-centric care and how to address PAD and CAD through a lens of patient-engaged medical management, according to a press release. Patients helped co-develop content on the hub, which includes materials for health care professionals to share with patients directly.
Clara Gomez-Sanchez, MD, assistant professor at the University of California, San Francisco, who appears in the hub’s video on patient-centered care for PAD, told Healio “PAD is getting more and more common. Right now, in medical schools and residencies, it’s very poorly addressed. It’s not really a big part of any curriculum, and I think it’s a major cause of disability in this country.”
Healio spoke with Bjork and Gomez-Sanchez about PAD and how the new learning hub can help close knowledge gaps. Their responses have been edited for length and clarity.
Healio: What was the need underlying this new virtual learning hub?
Gomez-Sanchez: PAD and CAD are more common than people realize. (Editor’s note: It is estimated that 8 million to 10 million Americans have PAD and more than 20 million Americans have CAD, according to information from the Vascular Cures press release.) The people who are most at risk often take the longest to diagnose, because they have many other medical problems that keep them from exercising, for example, so they often don’t notice some of the early signs. But the problem is that even those people who have more mild disease in PAD have been very clearly shown to have a higher rate of mortality. They have a higher risk of dying in the next 5 years than someone who does not have PAD, even if they’re completely asymptomatic. So, when we don’t diagnose it or we don’t notice it in these people, we’re missing a real chance to intervene on someone who is at risk for dying early.
There are a lot of medical and lifestyle-based interventions that, if early enough, can head the effects of PAD off at the pass before someone requires an amputation, before they end up not being able to walk a whole block, so then they become more and more deconditioned, their heart disease gets worse, they’re not able to live their lives independently, and so on.
It really starts with both providers and patients starting to understand that this is even a possibility, so that when somebody has early symptoms, you can intervene.
Bjork: We had a recent working group meeting with patients who have chronic limb-threatening ischemia resulting from PAD and across the board they highlighted a lack of awareness that their direct doctors or nurses had. In some cases, patients had symptoms and reported them, but the doctors didn’t know what it was until it got so bad that they had crossed the threshold into an area that was going to require life-challenging interventions. This is not surprising: Vascular disease is not studied in depth as part of the standard medical school curriculum. Many medical professionals report that no more than 1 hour of content in medical school was dedicated to vascular disease. There clearly is an education gap that we are hoping to address for nonspecialists, because the outcomes of PAD are very poor unless they’re addressed.
Healio: What are the main causes of PAD and CAD?
Gomez-Sanchez: Both PAD and CAD are atherosclerotic diseases. The most common symptom of both tends to be pain. If the blockage is in the arteries in the pelvis, then often people feel the pain in their buttock muscles or their thighs when they try to walk. If the blockage is in the coronary artery, then as people try to do more exercise or walk a little faster, the heart doesn’t get enough blood, and chest pain occurs.
Further, depending on where the blockage is, or how many, it sometimes gets to the point where there is so little blood flow that the tissue that’s furthest from the heart starts to die and gangrene can develop. It makes you very prone to infections, as well, in the feet. And then you cannot heal even a minor wound. So, someone stubs their toe or drops something on their foot that causes a little cut, and then they develop an infection or a growing wound that’s not healing, and then that’s usually when people are being diagnosed with very advanced PAD.
In the heart, it happens similarly. Over time, the muscle that has not been seeing enough blood flow often becomes weaker and people will develop HF.
Healio: How are these conditions treated?
Gomez-Sanchez: The first-line treatment is medication and behavioral interventions. We know smoking very much advances the build-up of these plaques, so stopping smoking is a primary goal. Exercise is also very important. A regular exercise program will help recover some function in the heart and in the legs, if started early enough that there’s not already too much damage.
The medications include those that control BP and blood sugar, statins and anticlotting agents like aspirin and rivaroxaban (Xarelto, Janssen/Bayer).
Once a patient gets to a certain point, surgery may be required to reopen the blockage, or to get blood around the blockage. There are many ways to do that today, including bypass surgery and endovascular techniques.
Healio: Who is at risk for PAD and CAD and what should medical professionals be aware of?
Bjork: Some people are more at risk for PAD and CAD than others. The chronic limb-threatening ischemia that results in amputations is the point where the racial disparities come in. Essentially, there’s either a lack of access to treatment, or at the touchpoints the people have; the information is not getting to them in the way that it needs to get to them so that the extreme versions can be avoided. Or there are disparities in care. But certainly, from an impact perspective, various minoritized communities are not getting the same care and results, so the disparities issue is huge.
It’s known that amputations are higher in the Black community. It’s also clear that other communities that don’t have ready access, or as much learning among the providers, are also being impacted. That includes rural communities. Underrepresentation is a massive issue here, at least with PAD.
Gomez-Sanchez: That is a big problem in the PAD world right now. We’re realizing just now many people are being left behind.
Bjork: It’s why we’re here. It’s why this hub matters.
Healio: Which brings us to the virtual learning hub. What is the importance of patient-centric care for PAD and CAD?
Gomez-Sanchez: For both of these conditions, some of the big risk factors are lifestyle-related. That requires behavioral change, and that’s a very difficult thing to achieve, but the more the health care professional talks to patients about behavioral changes, the more likely they are to achieve change. Also, this includes identifying what their current risk factors are, and then centering the interventions around that to decrease risk. The patient-centric approach involves talking to patients about smoking at each visit, encouraging lifestyle changes like increasing activity. You can’t simply take a pill and decrease risk for both PAD and CAD.
Once somebody has PAD and/or CAD, patient-centric care becomes more focused on long-term goals. For some people, they’re having so much pain that all they want is to not have pain anymore. That’s a very different goal from the person who says, “What made life worth living now that I’m retired is playing golf, and I can’t play golf anymore.” There are cultural and personal values that have to be considered. But if the health care professional and the patient don’t have goals that are aligned, you’re not going to get very far.
For more information:
Learn more about the PAD/CAD Virtual Learning Hub at https://vascularhealthequityacademy.org/course/pad-cad-virtual-learning-hub/.
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