AHA PAD Collaborative · Medicare Data 2003–2023

The Amputation
Heat Map

150,000 Americans lose a limb every year. Most amputations are preventable. Your congressional district has a number. Do you know it?

150K
Amputations / year
10–12M
Americans with PAD
Rate gap, highest vs. lowest districts
Scroll to explore ↓
The Crisis

Geography Is Destiny

Peripheral artery disease affects over 12 million Americans. It restricts blood flow to the limbs. When undetected and untreated, it leads to amputation — and amputation is frequently a death sentence. Five-year mortality after major amputation exceeds most cancers.

But here's the unbearable part: amputation rates vary up to five-fold between congressional districts. The South, Appalachia, and parts of the Midwest shoulder a wildly disproportionate burden — driven not by clinical severity, but by screening gaps, provider shortages, insurance barriers, and underinvestment in community health infrastructure.

The American Heart Association's PAD Collaborative built a heat map to make this visible. We've taken that data and the published evidence and made it impossible to ignore.

The Map

Amputations per 1,000
Medicare PAD Patients by State

States shaded by estimated amputation burden based on published CMS Medicare data patterns. Darker colors = higher rates. Hover or tap for details.

Lower
Higher
Data patterns derived from AHA PAD Collaborative Heat Map, CMS Medicare FFS Geographic Variation PUF, & published literature.
For precise district-level rates, explore the official AHA interactive map →
The Treatment Gap

We Know What Works. We're Not Doing It.

The treatments that prevent amputation are well-established: screening, antiplatelet therapy, statins, supervised exercise, and timely vascular consultation. The evidence base is decades deep. And yet the delivery of these basic interventions is shockingly poor — even in well-resourced areas.

This is not a knowledge problem. It's an implementation problem. And the districts with the highest amputation rates are the same districts where these interventions are least likely to be delivered.

What Should Happen — But Doesn't

No arterial test
32% of amputees
No statin Rx
67% of PAD pts
No antiplatelet
64% of PAD pts
Exercise Rx
2% referred
Source: Fanaroff et al., JAHA 2021; AHA PAD Scientific Statement 2024

What Works When Deployed

Limb teams
50% fewer amputations
Guideline Rx
65% lower mortality
Smoking stop
60% lower mortality
PAD screening
Early detection saves limbs
Source: AHA/ACC Guidelines; Armstrong Lab; Goodney et al., Circ Outcomes

32% of Medicare patients who underwent amputation received zero diagnostic arterial testing in the 12 months before losing their limb. Proximity to care does not equal access to care.

— Fanaroff et al., Journal of the American Heart Association, 2021
The Stakes

Worse Than Cancer

Amputation is not just limb loss — it is a harbinger of death. Five-year mortality after major amputation exceeds that of breast, prostate, and colorectal cancer. And yet federal research funding for diabetic foot disease lags cancer funding by orders of magnitude.

Lung cancer
80%
Major amputation
56.6%
Minor amputation
46.2%
All cancers (pooled)
31%
DFU alone
30.5%
Breast cancer
9%
5-year mortality · Armstrong DG et al., J Foot Ankle Res, 2020
$80B
Annual US cost of diabetic foot complications
ADA Economic Costs of Diabetes, 2017
600×
Research funding gap: DFU vs. other diabetes research
Armstrong et al., Diabetes Care, 2013
20s
Every 20 seconds, a limb is lost to diabetes worldwide
IDF / Boulton, The Lancet, 2005
Take Action

Does Your Representative Know?

Every congressional district has an amputation rate. Every representative votes on Medicare coverage, community screening programs, and health equity funding. This is their issue — whether they know it yet or not.

Find Your Representative

Enter your ZIP code to look up your congressional representative and see your district's amputation burden.

Explore Further

This Is Solvable

Where interdisciplinary limb preservation teams have been deployed, amputations have been cut in half. The evidence is clear. The tools exist. What's missing is awareness, political will, and resources directed to the communities that need them most.

Use these maps. Share them. Show them to your representative.
Ask: "Do you know where we are on the amputation heat map — and what are you doing about it?"