What follow‑up recommendations and questions should I ask this patient?

Follow-Up Recommendations and Key Questions for Patient Visits

Recommended Follow-Up Schedule

For patients with peripheral arterial disease (PAD), schedule follow-up visits at least annually, with more frequent visits (every 3-4 months initially, then every 6 months) for patients requiring closer monitoring based on disease severity and treatment complexity. 1

• Initial follow-up should occur within 1 month of starting new treatment to assess response and adherence 1
• After the first year of stable treatment, annual evaluations are appropriate for reliable patients who can report symptom changes 1
• Patients with multiple comorbidities, polypharmacy, or adherence concerns require visits every 3-6 months 1

Essential Questions to Ask at Every Follow-Up Visit

Symptom Assessment and Functional Status

Ask specifically: "Has your level of physical activity decreased since the last visit?" and "Have your symptoms increased in frequency or severity?" 1

• Assess limb symptoms including claudication distance, rest pain, or tissue loss 1
• Evaluate quality of life related to PAD after 3 months of optimal medical therapy 1
• Screen for new cardiovascular symptoms (chest pain, shortness of breath, neurological changes) 1
• Ask: "What activities can you no longer do because of your condition?" 1

Medication Adherence and Side Effects

Ask directly: "What medications are you taking? How and when are you taking them?" and request the patient demonstrate inhaler/medication technique if applicable. 1, 2

• Verify the patient brings all medications or a complete list (including names, doses, frequency) to the visit 1, 2
• Ask: "What problems have you had using your medications?" 1
• Screen for specific side effects that predict non-adherence: excessive urination, decreased sexual drive, weight gain, sedation 3, 4
• Assess medication tolerance: "How well are you tolerating your current treatment?" 1
• Check prescription fill data if available to objectively assess adherence 1

Cardiovascular Risk Factor Control

Systematically assess and document control of all modifiable cardiovascular risk factors at each visit. 1

• Blood pressure control and antihypertensive medication adherence 1
• Lipid management and statin therapy adherence 1
• Diabetes control (HbA1c if diabetic) 1
• Smoking status: "Are you currently smoking? Have you made any quit attempts?" 1
• Weight and nutritional status 1
• Exercise habits and physical activity level 1

Medication Reconciliation

Perform complete medication reconciliation at every visit, reviewing all prescription medications, over-the-counter drugs, supplements, and herbal remedies. 1, 2

• Document drug allergies with specific reaction details 2
• Check for drug-drug interactions using the electronic health record 1
• Review relevant laboratory data (eGFR, liver function) to determine if dose adjustments are needed 1
• Identify potentially inappropriate medications, duplicate therapies, or medications without clear indication 1, 2
• Ask: "Are there any medications that don't match up with your ongoing medical problems?" 1

Comorbid Conditions

Ask: "Have you developed any new medical problems or has the severity of known conditions changed?" 1

• Screen for conditions that can worsen PAD or complicate treatment 1
• Assess for depression, anxiety, or other mental health concerns affecting adherence 5, 4
• Evaluate cognitive function, particularly in older adults 1
• Review social support and logistic barriers to care 1, 5

Physical Examination Components

Perform focused cardiovascular examination including pulse assessment, blood pressure measurement, and vascular examination at each visit. 1

• Assess ankle-brachial index (ABI) or other hemodynamic parameters as clinically indicated 1
• Examine lower extremities for skin changes, ulceration, or tissue loss 1
• Perform duplex ultrasound assessment as needed based on clinical findings 1

Laboratory and Monitoring Requirements

Order laboratory tests based on medications prescribed and cardiovascular risk factors. 1

• Renal function (eGFR) at least annually, more frequently if on nephrotoxic medications or with baseline renal impairment 1
• Lipid panel to monitor statin therapy 1
• HbA1c if diabetic 1
• Check relevant drug levels when appropriate (e.g., anticoagulants) 1

Patient Education and Goal Setting

Clarify patient values, health outcome goals, and preferences at each visit using shared decision-making. 1

• Ask: "What matters most to you regarding your health?" 1
• Discuss advance care planning if not already completed 1
• Provide education about disease progression and treatment goals 1
• Assess patient understanding: "What questions do you have for me today?" 1

Red Flags Requiring Urgent Evaluation

Screen for symptoms requiring immediate vascular consultation: new rest pain, tissue loss, acute limb ischemia, or rapid symptom progression. 1

• New neurological deficits in the affected limb 1
• Non-healing wounds or gangrene 1
• Sudden onset of severe limb pain with pallor or pulselessness 1

Documentation Requirements

Document clinical status, functional status, medication adherence, cardiovascular risk factor control, and any changes to the treatment plan at each visit. 1

• Update medication list and share with patient 1, 2
• Record next follow-up interval and specific monitoring plan 1
• Communicate changes to other healthcare providers involved in patient care 1