Opinion

Curb Limb Loss in America

For the millions of Americans living with or caring for someone suffering from a chronic illness, the concept of loss is a familiar, yet unfortunate companion. Chronic illnesses such as heart disease and diabetes can strip away mobility, independence, productivity and quality of life. Even when properly diagnosed and well managed, these serious health conditions often demand significant changes in life and lifestyle.

Perhaps one of the most profound losses that can accompany chronic illness — and one that has become increasingly common — is the loss of a limb. More than 185,000 amputations occur each year in the United States — 54 percent of which are attributable to vascular disease.

It is vital to empower people affected by limb loss to reach their full potential, but it is also important to focus on preventing limb loss among populations at risk. Complicated by diabetes, heart disease, high cholesterol, smoking and even genetics, Peripheral Artery Disease narrows the blood vessels that supply the extremities, causing pain, reduced mobility, tissue death — and in the most severe cases, amputation. It is important to raise awareness about this issue.

Limb loss has indeed become a significant and growing health crisis across the United States, as the number of aging Americans and chronic illnesses continues to grow. Estimates suggest that anywhere from 12 to 20 percent of individuals over the age of 60 are living with PAD which could one day require amputation. It’s also important to note that African-Americans are at greater risk — up to four times more likely — to have an amputation than white Americans.

While individuals can go on to lead a full life with an amputation, the loss of a limb is associated with significant burden. Studies estimate the five-year mortality rate of persons with limb loss to be as high as 74 percent. Many living with limb loss experience barriers to participating in their communities and studies estimate the lifetime health care costs for a person with limb loss can be more than $500,000. Remarkably, this profound and complex loss can also be one of the most preventable.

During PAD Awareness Month this September, it’s overwhelmingly important for health care providers, patients, and policymakers to apply renewed focus towards preventing the amputation of a limb whenever possible. Indeed, it is estimated that upwards of 60 percent of amputations could be preventable through measures like patient education, regular visits with a doctor and/or podiatrist, and appropriate clinical intervention for vascular disease.

Health care providers and policymakers also have a responsibility to support appropriate clinical interventions that could help avoid amputation. Interventions like revascularization (which restores critical blood flow to affected limbs) has helped decrease the incidence of major amputations by 75 percent — yet these types of procedures may still not be widely available or routinely performed on some patient populations.

The benefits of these advanced treatment options, when appropriate, are noteworthy. Two-year mortality for revascularization patients falls between 16 to 24 percent, while amputees face mortality rates of up to 50 percent. And for payers, reduced amputations can mean huge health care savings: Annually, the immediate health care costs for the amputation of a limb — not including prosthetic costs or rehabilitation costs — total more than $8.3 billion.

The loss that comes with living with a chronic illness should not include losing a limb, when other treatment options are available to achieve the outcomes patients want. As we recognize PAD Awareness Month in September, I hope that providers and policymakers alike can move toward a greater understanding of this serious condition, and work together to empower patients in order to save limbs and save lives.

 

Jack Richmond is the interim president and CEO of the Amputee Coalition.

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