Over Half the Medicare Patients Who Have a Procedure to Open a Blocked Leg Artery Are Dead Within Three Years
You Don't Have to Lose Your Life or Your Leg
Over half the Medicare patients who have a procedure to open a blocked leg artery are dead within three years. At first glance, that seems odd, but it makes sense. Blocked leg arteries are especially common in patients who smoke or have diabetes. These people have a high risk for vascular events like heart attack, stroke, chronic kidney disease, and cancer. If they have a blocked leg artery, they have cholesterol deposits throughout their arteries that could rupture, cause a clot, and cause a heart attack or stroke. Researchers looked at almost 170,000 people who had a procedure to open a leg artery— 49% smoked, 51% had diabetes, 80% had high blood pressure, and 70% had high cholesterol. Those are the factors that blocked the arteries and created the dangerous cholesterol deposits.
This is a great example of the reason our medical system must change. The hospital where I worked in South Carolina sponsored periodic screenings for leg artery disease. The screening is done by comparing the blood pressure in the arm and the ankle. If the artery in the leg is blocked, the blood pressure in the ankle will be lower. Most of the patients had no symptoms such as a foot ulcer or pain with exercise that is relieved by rest. The screenings were done to identify patients for dye tests on the leg artery that might lead to surgery or a stent to open the vessel. The most authoritative professional body in American medicine says there is no evidence screening for blockage, doing expensive studies, and opening leg arteries in legs without symptoms provides any value. This small hospital developed the x-ray capabilities to do the diagnostic tests and stents. They also brought in vascular surgery. These are expensive procedures that keep hospitals full and generate revenue. They had no interest in developing the systems to make certain all these patients received optimal medical treatment. That hospital is by no means an exception.
In fact, a system focused on the blockages is usual care. It is the care that most patients receive. It identifies the blockages, and it does the tests, but it does not accomplish what is most important. It does an extremely poor job of attacking the biology that causes disease with optimal medical treatment. Blood pressure control is achieved in only 44% of Americans with hypertension. The best groups achieve 90%. The five goals for diabetes care are only achieved in 20% of patients. The best groups achieve 65-70%. Only about a third of patients with vascular disease are on a high-intensity statin. Teams designed to address these problems achieve much better results.
Optimal medical therapy (OMT) achieves performance equal to the best groups using medications have a beneficial impact beyond their effect on the target risk factor. Eating real food, intermittent fasting, podiatric care, appropriateprotective shoes, and exercise are equally important. Reducing excess pressure on certain parts of the foot makes ulcers less likely. The worst direct complication of leg artery Individuals on usual care have is leg amputation. Patients in usual care suffer three times as many amputations as patients on optimal medical treatment and they die eight years sooner. That is the direct result of focusing on blockages and failing to develop the systems to deliver optimal medical treatment consistently. OMT improves health at reduced cost. The rate of leg amputation is increasing. It is past time to make optimal medical treatment a universal standard of care for cardiovascular and related conditions. You can reduce your likelihood of amputation. You should be able to count on receiving optimal medical treatment consistently whether you are in Savannah or Seattle.