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.