Diabetes-related lower extremity amputations (LEA) disproportionately impact racial minorities and low-income groups. The Vascular Volunteers in Service to All (VISTA) assessment tool identified significant barriers to effective care from a patient’s perspective, including financial constraints, systemic issues, time and access limitations, knowledge gaps, and cultural and provider-related factors.
The Plenary Three paper—”VISTA: Targeting diabetes-related lower extremity amputations among underrepresented communities through a patient-centered multidisciplinary approach”—will see presenting author Paulette Torres Ruiz, MD, a clinical researcher at Baylor College of Medicine in Houston, deliver recent findings and future directions of the VISTA project. It is being held today (8:53–9:04 a.m. in the West Building, Level 3, Skyline Ballroom).
The paper will provide insights into designing a community-based awareness campaign to improve outpatient care accessibility and implement an internal systemic algorithm to promote limb salvage.
“Diabetes-related lower extremity amputations (LEAs) remain a devastating consequence for many individuals, particularly those from racial minorities and low-income backgrounds,” said Torres Ruiz. “Our study aimed to understand the factors contributing to these outcomes and how the VISTA assessment tool could help mitigate this issue.”
The paper will take an in-depth look at the VISTA assessment tool’s impact on non-traumatic amputations in a regional, urban and underserved community. Over the course of a year, 101 consecutive patients with diabetic foot ulceration or infection were enrolled in the study. The results were sobering: 63 LEAs were recorded, including 34 minor amputations, eight transmetatarsal amputations (TMA) and 21 below-the-knee amputations (BKA). Notably, 45 LEAs occurred at baseline admission, and 18 occurred during extended follow-up after discharge.
Torres Ruiz highlighted the primary barriers identified through the VISTA assessment tool, including financial constraints, systemic issues, time and access limitations, knowledge gaps and cultural and provider-related factors. “Our patients reported 83% dissatisfaction with diabetic foot care,” she noted. “Over half were uninsured, and a mere 50.5% had been treated at a wound care specialty clinic.”
The study’s findings underscored the necessity of a multidisciplinary approach, dubbed the Toe and Flow model, to reducing lower limb amputations due to diabetic foot ulcers or infections in marginalized and low-income minority groups. “By addressing these barriers and enhancing patient education, we can significantly improve limb salvage rates,” said Torres Ruiz.
SVS President Joseph Mills, MD, senior author, highlighted the importance of community-based interventions. “We need to focus on creating awareness campaigns to improve outpatient care accessibility,” said Mills. “Implementing an internal systemic algorithm to promote limb salvage is also crucial.”
A significant increase in major amputations, particularly below the knee, was observed during the three-month follow-up period. High Wound ischemia foot infection (WIfI) scores were predictive of increased risk of limb loss during the study.
“Our goal is to implement these findings into practical solutions that can be replicated in other underserved communities. The community-based awareness campaign is just the beginning,” said Mills.
The findings from the VISTA assessment tool and the proposed Toe and Flow model are intended to reduce the burden of diabetic lower extremity amputations in underserved communities.
“We have the data and the strategies,” said Torres Ruiz. “Now it’s time to act and make a tangible difference in the lives of those most affected by this condition.”
