Screening event targets hidden threat of amputation related to peripheral artery disease (PAD)
PAD is a leading cause of amputations in the U.S. But this serious circulatory condition often goes underdiagnosed and undertreated, so millions of Americans—especially in the Black community—don’t know they have it. Janssen’s Save Legs. Change Lives.™ aims to change that.
The Janssen Pharmaceutical Companies of Johnson & Johnson launched Save Legs. Change Lives.™ Spot Peripheral Artery Disease Now. It is a multi-year initiative to create urgency and action to address the hidden threat of peripheral artery disease (PAD)-related amputation. The initial focus is on reaching Black Americans, who are more than twice as likely to be impacted by PAD. Janssen has joined forces with leading professional associations, including the American College of Cardiology, as well as healthcare systems and community organizations to advance equitable care for individuals and communities at an increased risk for cardiovascular disease. Janssen Scientific Affairs, LLC is proud to support the American Heart Association’s PAD National Action Plan, which aims to reduce PAD-related amputations.
The Personal Side of PAD: How Janssen Is Working to Save Legs and Change Lives
Pamela J. Price-Parker, of Washington, D.C., juggles many roles, including health and physical education teacher, WomenHeart Champion (a nonprofit organization seeking to improve the health and quality of life of women living with heart disease), and PAD patient advocate. In 2009, Pam was diagnosed with PAD, a narrowing of the peripheral arteries that carry blood from the heart to other parts of the body. She immediately underwent surgery to clear blockages in her legs. Then, in 2014, she suffered a heart attack.
After living through these cardiovascular events, Pam has been on a mission to educate and motivate others on the physical and emotional aspects of heart and vascular disease prevention. Pam detailed her experiences on ABC’s Good Morning Washington and with the U.S. House of Representatives. She has also participated in Capitol Hill briefings and many other events engaging lawmakers to inform future health policy. In October 2014, Pam became a WomenHeart Champion, sharing her story with others. She is in the process of writing a children’s book titled “I Love My Heart.” Pam is inspired by her daughter to keep moving forward on this journey, not only for her but for all the children she teaches each day.
As was the case with Pam, PAD can trigger a heart attack. It can also lead to leg or foot amputation or stroke. Save Legs. Change Lives. ™ Spot Peripheral Artery Disease Now is part of the Johnson & Johnson broader initiative, Our Race to Health Equity (ORTHE), which aspires to help eradicate racial and social injustice as a public health threat by eliminating health inequities for people of color.
Pierre Theodore, M.D., Vice President, Health Disparities for Johnson & Johnson Global Public Health, and his teams, focus on various health inequities worldwide. “We work on understanding the challenges of delivering equitable and affordable healthcare in low resource settings,” said Dr. Theodore. “We noticed that these same issues that come up in those environments also come up in diverse communities within more highly resourced environments,” he added.
Black Americans are also 25 percent less likely to receive a medical procedure to restore the blood flow to their legs before an amputation. Blacks and Hispanics historically have less access to quality, vascular healthcare.
Creating a Health Equity Task Force to Reduce PAD
In 2021, the Janssen Cardiovascular and Metabolism team (CVM) started a Health Equity Task Force to identify a specific health equity issue and work to develop solutions.
“Reduction of PAD and the resulting amputations in Black Americans became our North Star,” said Richard Browne, M.D., Senior Medical Executive, Cardiovascular and Metabolism Medical Affairs at Janssen. Dr. Browne, who practiced cardiology in Charlotte, North Carolina, for over 20 years, decided to join Janssen, even though he loved clinical medicine. “I wanted to do something that could impact a much broader range of patients and address health disparities,” said Dr. Browne.
But his work is also very personal. His father-in-law, Russell, was a living example of bad outcomes in PAD. “One limb after another, he lost his left leg, right arm, and right leg. Ultimately, he passed away before age 60, before he could ever meet his grandson, Ricky, who is now 15,” stated Dr. Browne. “Many people who undergo limb amputation because of PAD die within three years, but it is preventable, which is the focus of initiatives like Save Legs. Change Lives.”
According to the American Heart Association’s Circulation Research Journal, Black Americans are two times more likely than white Americans to have blockages in the blood vessels in their legs that can lead to PAD. “They are also diagnosed with PAD at a later stage when the disease is more severe and vulnerable to PAD complications, such as amputations,” stated Dr. Browne. “Black Americans are also 25 percent less likely to receive a medical procedure to restore the blood flow to their legs before an amputation. Blacks and Hispanics historically have less access to quality, vascular health care.”
There are three pillars to the Save Legs. Change Lives.™ initiative: driving research, powerful partnerships and empowering individuals. A major component of the program is casting a wide net to “attempt to raise awareness to help identify Black people who are living with PAD but may be undiagnosed or untreated by their physicians,” said Dr. Browne. It is estimated that 20 million people of all races living in the U.S.1 have PAD. Yet only 8.5 million are diagnosed.2
“Screening for PAD is conducted through an arterial brachial index (ABI), a non-invasive test,” stated Dr. Browne. During the screening, patients remove their socks and shoes, and then blood pressure cuffs are placed on the upper arm and the lower leg. Both blood pressures are checked. Optimally they should be the same number. “But when you develop PAD, the blood pressure in the leg starts to go down,” explained Dr. Browne.
Reducing Amputations Through Community Outreach
Community outreach has begun through Empower-PAD, Janssen’s mobile health unit that travels to vulnerable communities, bringing PAD screening and patient education directly to communities nationwide. In September 2022, the Janssen team collaborated with The Balm in Gilead, a Black health-focused organization, to raise awareness and provide education for underserved communities in Chicago. Over 500 individuals came out for PAD screenings at the piloted Save Legs. Change Lives.™ community event. The event also included a patient education component that explained the risk factors and the impact if PAD is left undiagnosed or untreated.
“It is important that we make people aware that smoking, diabetes, hypertension, high cholesterol and obesity can increase their risks of PAD,” Dr. Browne said. “With that information, they can talk to their healthcare providers and potentially be screened appropriately.”
“Team efforts often succeed where individual heroics fail, and PAD is no exception,” said Avery Ince, M.D., Ph.D., Vice President of Medical Affairs in Janssen’s Cardiovascular Franchise. “There are multidisciplinary limb preservation programs across the nation in which vascular surgeons and interventional cardiologists are working with interventional radiologists, podiatrists, wound-care specialists and other specialists, to preserve the leg” Dr. Ince said. “Some of these programs have enjoyed considerable success, and we intend to work with them to broadly disseminate information about best practices in this area.”
According to Dr. Ince, some patients with advanced PAD who arrive at a hospital emergency department with a leg that is cold, or painful, or has ulcers or slow healing wounds, can be at high risk of undergoing a leg amputation during that hospitalization. Since leg amputation is associated with a 70 percent mortality rate within three years of undergoing the procedure, Janssen is collaborating with professional societies like the American Heart Association to reduce amputations by 20 percent by 2030, and has developed a Save Legs. Change Lives.™ campaign website where patients can find educational resources about the disease.
One of the Our Race to Health Equity focus areas is investing in community-based healthcare solutions that build trust and improve the quality and utilization of healthcare. This encompasses developing and improving health care models to enhance cultural competency and respect in health care services.
“Patient healthcare is improved when people experience highly competent care delivered in a culturally competent context,” stated Dr. Theodore. “Trust is the foundation of a successful relationship between patients and care providers. Therefore, we strongly believe that an increase in the number of physicians and nurses sensitive to the needs of at-risk Black patients will improve outcomes.” he noted.
Accelerating Impact with the Health Equity Assessment Tracker (HEATMap)
On the research and data side, the Health Equity Assessment Tracker (HEATMap), a comprehensive tool developed to help identify U.S. counties experiencing racial health inequities to access care, is being used specifically for PAD.
“The idea of a customer-facing health disparities tool originated in MedTech,” stated Joyce LaMori, MHS, MBA, Group Director in Population Health Research at Janssen. The collaboration that led to the development of HEATMap PAD is a remarkable example of cross-sector collaboration among diverse teams within Johnson & Johnson. We’ve been able to move quickly with our collective focus on innovating for health equity.”
“We’ve since been able to accelerate our work on the HEATMap and its impact, thanks to the funding received from Our Race to Health Equity Business Matching Fund, which matched our existing financial investment in the tool’s development,” added LaMori.
Through this work, as well as ongoing education, awareness and screening initiatives such as Empower-PAD, Janssen proudly endeavors to reach people placed at greatest risk, empowering individuals and communities to change the trajectory of their health.
1 Cardiovascular Coalition. Racial Disparities in Vascular Care. (n.d.). Accessed March 11, 2022 from https://cardiovascularcoalition.com/our-patients/racial-disparities-in-vascular-care/
2 American Heart Association. PAD Toolkit for Health Care Professionals. Accessed March 11, 2022, from https://www.heart.org/en/health-topics/peripheral-artery-disease/pad-toolkit