Mental health is a key, but often overlooked, aspect that should be included in treatment and follow-up of patients with severe peripheral artery disease (PAD), researchers urge in a newly published review article.
Kim G. Smolderen, PhD, of the Vascular Medicine Outcomes Program, Yale University, New Haven, Connecticut, and colleagues described potential solutions to address this need in a manuscript published Monday online and in the March 28 issue of the Journal of the American College of Cardiology.
Globally, 220 million people have lower-extremity PAD. In the U.S., roughly 3.3 million people are admitted each year to the hospital for PAD. Rates of the most severe form of PAD — critical limb ischemia (CLI) — have increased in individuals age 65 and younger and represent >50% of CLI patients. Many patients with PAD are also from marginalized groups, which further highlights the inequities in the healthcare system.
Mental health conditions are common in young patients with PAD, along with other comorbidities, such as obesity (40%) and smoking (46%), and around 37% of young women with PAD have a mental health condition. Mental health conditions often cascade into negative behaviors, such as smoking, physical inactivity and improper nutrition. Depression and anxiety increase risk of major physical health and financial problems.
The authors of this article noted that care systems need to address four primary domains in patients with PAD: mental health conditions, health behaviors, how patients experience pain and the effects of the experience of having PAD, as these have traditionally been neglected. Treatment plans should integrate psychological and psychiatric interventions to address these issues.
PAD care teams should be interdisciplinary and centered around behavioral health care, and there should be continuous good communication between patients and providers. Psychiatrists should be available for consult if mental health conditions are treatment resistant and require pharmacotherapy.
The authors offered solutions to reshape the integration of care model for PAD patients. First, policy change is needed at the state and national levels, as well as consistent advocacy. The American Psychological and Psychiatric Associations will need to put forth effort for care of patients with PAD, the authors said.
Second, the authors noted the importance of sustainable care, rather than highly technological and costly treatments. Thresholds for mental health screenings and training models will be needed to implement patient-centered care in this population.
Third, health administrators must educate themselves about how clinical health psychologists, psychiatrists and other practitioners manage patients with chronic diseases and advocate for these providers to participate in long-term care of these patients. Health disparities should be addressed to establish expectations of collaboration and team-based training to move away from a hierarchal care system.
Finally, the authors emphasized the importance of evidence-based care and workflow. Budgets need to be expanded to include research on these proposed solutions to wholly caring with patients for PAD. Clinical, operational and financial procedures and standards should be addressed in research on the state and national levels.
Overall, these investigators concluded more research must be performed to enhance the quality of care and reduce the burdens of comorbidities in patients with PAD.
“Areas of priority have been identified, but are not limited to the ones discussed. Areas not covered include rehabilitation (psychology) following amputation, the impact of cognitive functioning in systemic vascular disease, grief and trauma, and end-of-life care,” the authors wrote. Comprehensive management of PAD will integrate several approaches to care, and bring new research to further develop intervention guidelines.
Smolderen KG, Samaan Z, Ward-Zimmerman B, et al. Integrating Psychosocial Care in the Management of Patients with Vascular Disease. J Am Coll Cardiol 2023;12:1201-1204.
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