Building Your Peripheral Artery Disease Toolkit: Medical Management of Peripheral Artery Disease in 2022

Bhagirath, Vinai; Nash, David T.; Wan, Darryl; Anand, Sonia S.

doi:10.1016/j.cjca.2022.02.004

Cited by 11 publications

(10 citation statements)

References 98 publications

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“…Compared to others performed by this group, this study alluded to a high prevalence of T2DM, which is inextricably linked to negative remodeling, potentially resulting in a smaller caliber vasculature [ 34 ]. We did not record pre-procedural cardiovascular medications, such as antithrombotic therapies and vasodilators, which may possibly impact RAO [ 35 - 36 ]. Additionally, it has been demonstrated that Trinidadian South Asian patients have accentuated platelet reactivity and a smaller caliber of coronary arteries, both for pathophysiological and anatomical reasons that could plausibly contribute to RAO [ 37 - 38 ].…”

Section: Discussionmentioning

confidence: 99%

Effectiveness and Safety of Left Distal Transradial Access in Coronary Procedures in the Caribbean

Seecheran,

Leyva Quert,

Seecheran

et al. 2024

Cureus

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Introduction: This retrospective study investigated the effectiveness and safety of left distal transradial access (LDTRA) in patients with cardiovascular disease in Trinidad undergoing coronary angiography (CAG) or percutaneous coronary intervention (PCI). Method: Procedural parameters, including technical success and safety outcomes such as vascular complications and radial artery occlusion (RAO), were assessed in 111 consecutive patients undergoing CAG or PCI from January 2023 to June 2023 at the Eric Williams Medical Sciences Complex, Trinidad and Tobago. Eighty-eight patients underwent LDTRA, while 23 received left transradial access (LTRA). Results: There was no difference in procedural success with LDTRA compared to LTRA, 90.9% vs. 100%, p -value 0.202, non-significant (ns). LDTRA was associated with shorter fluoroscopy times (8.4 ± 6.8 minutes vs. 12.4 ± 7.7 minutes, p -value = 0.02), procedural duration (26.7 ± 18 minutes vs. 35.8 ± 20 minutes, p -value = 0.04), and hemostasis time (142 ± 41 minutes vs. 186 ± 44 minutes, p -value < 0.05). There were no significant differences in procedural-related complications (8% for LDTRA vs. 4.3% for LTRA, p -value = 0.476, ns). There were no reported cases of RAO. In the subgroup of patients with prior coronary artery bypass grafting (CABG), the fluoroscopy and procedure times were similar for both access sites; however, LDTRA was associated with a shorter hemostasis time (128 ± 30 minutes vs. 194 ± 39 minutes, p -value = 0.01). Conclusions: LDTRA is effective and safe for coronary procedures and is associated with a shorter hemostasis time. This study may prove clinically pertinent in a limited-resource Caribbean setting.

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Section: Discussionmentioning

confidence: 99%

Effectiveness and Safety of Left Distal Transradial Access in Coronary Procedures in the Caribbean

Seecheran,

Leyva Quert,

Seecheran

et al. 2024

Cureus

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“…Existing literature on challenges in PAD care acknowledges implementation barriers at the level of the patient, health care provider and health system. (16) In exploring the needs and challenges of those with lived experience of PAD, and clinicians involved in their care, there is an overwhelming preponderance of system-level barriers . This need for system-level transformation is echoed in the challenge defined by study participants: “How might we help patients to have early, easy access to health care advice and treatment, because we want to address the disease throughout the spectrum, not just at the urgent/late stage?” The proposed solutions are also all system-level changes.…”

Section: Discussionmentioning

confidence: 99%

“…This may be due to implementation barriers occurring at the level of the patient, health care provider, or health system; examples include poor awareness and understanding of PAD as a diagnosis and disease, cost of medications, lack of clarity regarding which healthcare provider is responsible for optimizing secondary prevention, and lack of access to comprehensive secondary prevention programs. (16) Barriers to appropriate, effective and timely care are particularly consequential for patients with low socioeconomic status and/or residing in rural areas, who have higher rates of presentations with complications, higher rates of emergency surgeries, and higher amputation rates. (17,18)…”

Section: Introductionmentioning

confidence: 99%

Underdiagnosed and undertreated peripheral arterial disease: Using design thinking to establish priorities for peripheral arterial disease care

Joseph,

Park,

Chan

et al. 2023

Preprint

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IntroductionDesign thinking (DT), a methodology for solving complex problems, has the potential to create powerful, human-centred healthcare improvement. We applied DT methodology to the context of peripheral arterial disease (PAD). PAD is increasingly prevalent globally and associated with significant morbidity and mortality. We fall short of achieving effective secondary prevention due to persistent underdiagnosis and undertreatment of this disease. In this study, we sought to identify novel and creative solutions to improve diagnosis and secondary prevention of PAD.MethodsWe describe the initial ‘Empathize’, ‘Define’, and ‘Ideate’ stages of the five-stage DT model proposed by the Hasso Plattner Institute of Design at Stanford University. We engaged patients with PAD, caregivers, clinicians, and other stakeholders in a co-design process using semi-structured interviews, a DT workshop, and post-workshop survey. Data from the interviews and workshop were analyzed using inductive thematic analysis, and data from the survey were analyzed using an idea prioritization matrix.ResultsExploring the lived experience of those with PAD and those delivering PAD care emphasized the influence of system-level barriers. Many of the solutions proposed by workshop participants target evidence-based, system-level interventions through improved funding support, institutional support, outreach efforts and technological applications. The connections between insights derived in the ‘Empathize’ stage and solutions proposed during the ‘Ideate’ stage showed the success of the co-design process in inspiring empathy-driven solutions.DiscussionThis study demonstrates how DT methodology can be applied to complex healthcare problems such as PAD care, to systematically develop human-centred solutions. In the next stages of this study, we will use the results of this co-design process to iteratively implement, evaluate, and optimize the proposed solutions which were prioritized as being most feasible and high impact.KEY MESSAGESWhat is already known on this topicPeripheral arterial disease (PAD) is increasingly prevalent globally. The significant morbidity and mortality associated with PAD can be reduced with timely diagnosis and the effective use of secondary preventative therapies; however, PAD remains underdiagnosed and undertreated compared to other atherosclerotic diseases.What this study addsThis study is novel in its application of design thinking methodology and a co-design approach to work together with people with lived experience of PAD, to establish priorities for PAD care.How this study may affect research, practice or policy – Insights from this study emphasize system-level barriers which prevent effective delivery and uptake of PAD care. Solutions that are human-centred and co-produced with patients and key stakeholders should improve institutional and governmental support for implementation of evidence-based best practices; this will be investigated further in the next stages of this study.

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“…In addition, early detection and treatment of complications like wounds by continuous patient monitoring are of outstanding importance. 72 Also, patients' education on maintaining health by best possible adherence to conservative therapy including lifestyle modification and physical exercise is of crucial relevance. 52 …”

Section: Discussionmentioning

confidence: 99%

“…Starting with primary prevention and an increased awareness, especially vulnerable groups should be examined and optimally treated for cardiovascular risk factors. In addition, early detection and treatment of complications like wounds by continuous patient monitoring are of outstanding importance 72 . Also, patients' education on maintaining health by best possible adherence to conservative therapy including lifestyle modification and physical exercise is of crucial relevance 52 …”

Section: Discussionmentioning

confidence: 99%

Temporal trends in patients with peripheral artery disease influenced by diabetes mellitus in Germany

Schmitt

Hobohm

Vosseler

et al. 2022

Journal of Diabetes

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Introduction In patients with peripheral artery disease (PAD) the presence of diabetes mellitus (DM) is associated with higher morbidity and mortality. Because huge efforts are made to improve medical care of patients with DM including chronic disease programs, the aim of the present study was to investigate temporal trends regarding the clinical burden of DM on PAD patients within a 15‐year observational period. Methods We analyzed all patients hospitalized because of PAD between 2005 and 2019 in Germany stratified regarding DM. Results Overall, 2 654 871 hospitalizations of PAD patients (865 823 with DM) were included. Hospitalizations based on PAD inclined from 142 778 in 2005 to 190 135 in 2019 ( β 3956 per year; 95% confidence interval [CI] 3034–4878, p < .001) with simultaneous increase of hospitalizations of PAD patients with DM (2005: 41609 (29.1%) versus 2019: 65 302 (34.3%); β 2019 per year [95% CI 1593–2446], p < .001). Amputation rates ( β −0.42 [95% CI −0.44 to −0.40]; p < .001) as well as in‐hospital case‐fatality rate (2005: 4.7%, 2019: 2.8%; β −0.64 [95% CI −0.69 to −0.59]; p < .001) decreased in diabetic PAD patients during the observational time. In spite of improved morbidity and mortality in the last years of the observational period, patients with DM still suffered from an increased risk for morbidity and mortality during the observational period compared to nondiabetic PAD patients. Conclusions Despite the progress in DM treatments, DM still was associated with an unfavorable clinical patient profile and remained a substantial risk factor for morbidity and mortality in hospitalized patients with PAD and DM in Germany between 2005 and 2019.

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Building Your Peripheral Artery Disease Toolkit: Medical Management of Peripheral Artery Disease in 2022

Cited by 11 publications

References 98 publications

Effectiveness and Safety of Left Distal Transradial Access in Coronary Procedures in the Caribbean

Effectiveness and Safety of Left Distal Transradial Access in Coronary Procedures in the Caribbean

Underdiagnosed and undertreated peripheral arterial disease: Using design thinking to establish priorities for peripheral arterial disease care

Temporal trends in patients with peripheral artery disease influenced by diabetes mellitus in Germany

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