24
Diagnosis
Table 10. Geriatric Syndromes and Considerations in the
Management of PAD in Older Patients
Consideration Characterization
Frailty • Can be assessed among patients with PAD using measures such
as the Clinical Frailty Scale, the modified Frailty Index, the Risk
Analysis Index, and others.
• Elevated rates of MACE associated with frailty and claudication.
• Two-y survival rate was reduced depending on degree of frailty in
patients undergoing revascularization for CLTI.
• Frailty is highly predictive of 30-d mortality rate for all PAD
revascularization procedures.
Sarcopenia • Age-related loss of muscle mass
• Sarcopenia was 10 times more prevalent in those with PAD than
age-matched controls without PAD.
• Sarcopenia is associated with lower survival rate and higher risk of
MACE and MALE.
• Patients with sarcopenia are at increased risk for muscle mass loss
in the lower extremities.
Malnutrition • Common in older patients with PAD, affecting up to 50% of
individuals.
• Five-y survival rate in those with PAD is directly related to GNRI
stratification of nutritional risk.
• In patients with CLTI, 30-d mortality was 5 times higher in those
with severe malnutrition compared with those with moderate or
no malnutrition.
• Five-y amputation-free survival rate in patients undergoing
surgical revascularization for CLTI was worsened relative to
poorer nutritional status.
4.3. Considerations in Management of PAD in Older Patients
COR LOE
Recommendation
2a B-NR
1. In older patients (ie, ≥75 years of age) with PAD, assessment
for geriatric syndromes (Table 10), such as frailty, sarcopenia,
malnutrition, and mobility impairment, can be useful to
identify high-risk patients, including before revascularization,
and to provide safe and goal-concordant care.
4.2. Health Disparities in PAD
COR LOE
Recommendation
1 C-EO
1. Clinicians and health care systems should actively pursue
evidence of health disparities in diagnosis, treatment, and
outcomes for patients with PAD and use efforts to limit the
impact of these disparities on clinical outcomes.
