2024 ACC Peripheral Artery Disease (PAD) Guidelines

• Collaborative vascular care is emphasized to address health disparities, gaps in medical therapy, structured exercise, and good foot care along with appropriate revascularization to prevent limb loss.

• The new guidelines update the 2016 guidelines and call for broad implementation of the Peripheral Artery Disease (PAD) National Action Plan to improve outcomes.

• Emphasis on rigorous medical therapy for all patients with PAD, regardless of clinical subset.

• Introduction of new medical therapies:

  • Low-dose rivaroxaban combined with low-dose aspirin for symptomatic PAD and post-revascularization patients.
  • SGLT2 inhibitors and GLP-1 receptor agonists for diabetes patients to prevent major adverse cardiovascular events (MACE).
  • PCSK9 inhibitors and ezetimibe for patients with high low-density lipoprotein cholesterol (LDL-C).

• Recognition of depression as a prevalent comorbidity in PAD with recommendations to use the Geriatric Depression Score (GDS) and Patient Health Questionnaire-9 (PHQ-9) for assessment.

• Expanded focus on health disparities and social determinants of health affecting PAD across race, ethnicity, and income level.

• Emphasis on longitudinal follow-up and broad adoption of quality measures for PAD care to reduce amputation rates by 20 percent by 2030.

• Expanded exercise recommendations:

  • Supervised exercise therapy (SET) for chronic symptomatic PAD, with or without revascularization.
  • Structured community-based exercise programs with behavioral change techniques.

• New emphasis on foot care across the spectrum of PAD, including preventive foot care and the role of foot care professionals in managing chronic limb-threatening ischemia (CLTI).

• Consistent theme of collaborative vascular care, particularly team-based care for CLTI to improve patient outcomes.