Special Report Peripheral Arterial Disease: Lack of Awareness in Canada The First Canadian P.A.D. Public Awareness Survey Peripheral Arterial Disease: Lack of Awareness in Canada. Canadian Journal of Cardiology, 2009, in press

on behalf of the Peripheral Arterial Disease Coalition Contributors Marge B. Lovell, RN Kenneth Harris MD Thomas Forbes MD Beth Abramson MD Gwen Twillman Paul Schroeder, MA Michael H. Criqui, MD, MPH Emile R. Mohler, III, MD Alan T. Hirsch, MD on behalf of the Peripheral Arterial Disease Coalition

National P.A.D. Public Awareness Survey Background Lower extremity peripheral arterial disease (P.A.D.) is common, affecting up to 12% to 29% of the elderly and approximately 800,000 Canadians. Intermittent claudication is the most frequent symptom of P.A.D. and impairs quality of life and functional status. Individuals with P.A.D. suffer a 5-fold increased relative risk of a heart attack and stroke and total mortality that is 2-3 fold greater than those without P.A.D. Individuals with P.A.D. suffer combined annual rates of heart attack, stroke, and hospitalization that are comparable to, or greater than, rates observed in individuals with established coronary artery disease or stroke. … but if the public is not aware of this risk, how can the risk be lowered?

National P.A.D. Public Awareness Survey Objectives Obtain baseline data to quantify public knowledge of the causes (risk factors), symptoms, and ischemic risks  to life and limb  of P.A.D. Results intended to serve as a benchmark so that improvements in awareness can be documented over time. Peripheral Arterial Disease: Lack of Awareness in Canada. Canadian Journal of Cardiology, 2009, in press

National P.A.D. Public Awareness Survey Methods 10-minute telephone survey used a Random Digit Dialing (RDD) sampling procedure to draw a national probability sample Survey administered to: National cross-section of 501 Canadians ages 50+ years Conducted from 6/5/2006 to 7/5/2006 Interviews were conducted in English and French Results were weighted by age and gender to reflect 2006 Canadian census estimates Peripheral Arterial Disease: Lack of Awareness in Canada. Canadian Journal of Cardiology, 2009, in press

The Survey Population Demographics Total Sample, n (%) 501 (100) Gender Male Female 233 (46.4) 268 (53.6) Age 50-59 60-69 70-79 80+ 209 (41.6) 136 (27.2) 103 (20.6) 53 (10.5) Race White Black Aboriginal Asian Other 466 (93) 3 (0.7) 8 (1.6) 10 (1.9) Peripheral Arterial Disease: Lack of Awareness in Canada. Canadian Journal of Cardiology, 2009, in press

The Survey Population Demographics Total Sample, n (%) 501 (100) Education ≤ High School > High School 301 (60.1) 194 (38.7) Income < $40,000 ≥ $40,000 233 (46.6) 192 (38.3) Peripheral Arterial Disease: Lack of Awareness in Canada. Canadian Journal of Cardiology, 2009, in press

The Survey Population Demographics Risk Factors and CV Diseases Risk Factor or CVD Percentage High blood pressure 43.4 High cholesterol 36.7 Diabetes 12.0 Smoking History Current 18.2 Past 40.5 Never 41.1 Chest pain or angina Heart attack 10.0 Coronary bypass surgery or angioplasty 7.6 Stroke 4.2 Mini-stroke or TIA 5.8 Carotid artery surgery or stenting 1.8 P.A.D. Peripheral Arterial Disease: Lack of Awareness in Canada. Canadian Journal of Cardiology, 2009, in press

P.A.D. Symptoms Do you currently have ___ ? Percentage of respondents Peripheral Arterial Disease: Lack of Awareness in Canada. Canadian Journal of Cardiology, 2009, in press

Key Findings

Two Out of Three Adults Surveyed Are Not Familiar with P.A.D. How familiar are you with P.A.D.: very familiar, somewhat familiar, not too familiar or not at all familiar? P.A.D. Aware (36%) Not Aware of P.A.D. (64%) “P.A.D. Aware” defined by “somewhat” or “very familiar” responses Peripheral Arterial Disease: Lack of Awareness in Canada. Canadian Journal of Cardiology, 2009, in press

How familiar are you with the following conditions: P.A.D. Awareness Is Markedly Lower Than Other Cardiovascular Diseases and Risk Factors How familiar are you with the following conditions: very familiar, somewhat familiar, not too familiar or not at all familiar? High blood pressure Stroke Coronary artery disease Congestive heart failure P.A.D. Percentage very or somewhat familiar 80 74 79 48 72 36 Diabetes High cholesterol 51 Peripheral Arterial Disease: Lack of Awareness in Canada. Canadian Journal of Cardiology, 2009, in press

P.A.D. Awareness by Age and Gender How familiar are you with P.A.D.: very familiar, somewhat familiar, not too familiar or not at all familiar? 37 39 32 % very or somewhat familiar % very or somewhat familiar 23 33 Peripheral Arterial Disease: Lack of Awareness in Canada. Canadian Journal of Cardiology, 2009, in press

P.A.D. Awareness by Education and Income How familiar are you with P.A.D.: very familiar, somewhat familiar, not too familiar or not at all familiar? 40 46 32 31 % very or somewhat familiar % very or somewhat familiar 29 23 Peripheral Arterial Disease: Lack of Awareness in Canada. Canadian Journal of Cardiology, 2009, in press

Perceived Causes of P.A.D. Among Those “P.A.D. Aware” Does ____ increase the risk of getting P.A.D. not at all, a little, some, a moderate amount or a lot. Combined Responses: A Lot & Moderate Amount Overweight Cigarette smoking Lack of exercise Diabetes High cholesterol Heart attack or stroke Personal history MI/stroke Drinking alcohol Percentage 58 57 51 55 49 44 36 High blood pressure 37 Peripheral Arterial Disease: Lack of Awareness in Canada. Canadian Journal of Cardiology, 2009, in press

Perceived Consequences of P.A.D. Among Those “P.A.D. Aware” Based on what you know or have heard, what can P.A.D. lead to if not treated? % of “P.A.D. Aware” respondents 21 12 7 6 21 20 2

Few Canadians First Learn About P.A.D. through Health Care Providers At Work (5%) Other (15%) TV (28%) Family & Friends (18%) Magazine/Newspaper (15%) Health Care Provider (19%) Internet (3%) Radio (1%) Peripheral Arterial Disease: Lack of Awareness in Canada. Canadian Journal of Cardiology, 2009, in press

Conclusions Few (about two in three) Canadians are aware of P.A.D. Those Canadians at risk for P.A.D. do not know its causes and thus cannot take steps to prevent it. Few Canadians know that having P.A.D. markedly increases one’s short-term risk for heart attack, stroke, amputation and death. Those who are aware of P.A.D. rarely first learn about it from health care providers.

Conclusions P.A.D.-related knowledge is far below that of other comparable or lower risk cardiovascular diseases. These findings reinforce the need for national educational efforts on P.A.D. Health professionals, the media, the healthcare industry, and government agencies share a responsibility to work together to inform the public about this common cardiovascular disease.

The P.A.D. Coalition The P.A.D. Coalition aims to deliver consistent, evidence-based P.A.D. messages to the public and the health care community. New tools are available to help medical practices, hospitals, health plans and health systems educate their patients and clinicians about P.A.D. Visit www.PADCoalition.org