Screening: A Success Story in the Epicenter of the PAD Epidemic

When Dr. Foluso Fakorede, an interventional cardiologist, moved to the Mississippi Delta, he was shocked by the extent of the PAD epidemic across the state, especially amongst the Black and African American community. Mississippi is home to the highest percentage of African Americans of any state in the U.S. What is an ABI test? An ankle-brachial index (ABI) test is a simple way to check how well a person’s blood is flowing. When a patient has PAD, blockages exist limiting oxygen to the limbs. The ABI test compares the blood pressure at the ankle with the blood pressure at the arm. If the blood flow at the ankle is low, the patient may have PAD.

fakoredeIn the year prior to his arrival, his local hospital performed 56 major amputations and zero diagnostic tests for PAD. Moreover, more than nine in 10 amputees he met had never had a diagnostic test for PAD or an appropriate vascular evaluation to salvage their limbs. Knowing that non-traumatic amputations can be avoided with the proper care, Dr. Fakorede set out to turn the tide by organizing a proactive campaign to screen individuals in high-risk communities for PAD.

Setting to work, Dr. Fakorede quickly created a care team to educate, screen, diagnose and treat the community’s most at-risk patients. Since many at-risk people are asymptomatic until it’s too late to save their limbs, Dr. Fakorede’s team decided to meet people where they were in the community, including schools, churches and health fairs.

In addition to arming individuals with information about cardiovascular health, Dr. Fakorede’s team distributed a health questionnaire, which was used to identify individuals most at risk for PAD. Only when an individual exhibited risk factors – including diabetes, nicotine use, heart disease, kidney disease and hypertension, among others – was that person screened. Seeing the benefits early screening brought to the community, many church leaders invited Dr. Fakorede to speak to their congregations and encourage them to ask their physicians about getting screened for PAD and cardiovascular disease. Interventional care was only provided when clinically appropriate, which resulted in far fewer amputations across the area.

In just one year, the results were remarkable. Through the efforts of Dr. Fakorede’s team, the local hospital performed nearly 500 diagnostic tests and just seven amputations, equaling a dramatic 87.5 percent decrease. While the USPSTF may have found no evidence to support the benefits of PAD screening, Dr. Fakorede’s experience shows how early detection can save the limbs—and lives—of people in high-risk communities.

Dr. Fakorede’s experience suggests that high-risk communities benefit greatly from increased access to screening and early detection for PAD.