Aiden Kirkham (left) and Dr. Derek Roberts (right)A new international study published in The Lancet eClinicalMedicine has found a gap in the treatment of adults with peripheral artery disease (PAD), a serious condition that affects blood flow to the limbs and increases the risk of pain, heart attack, stroke, limb amputation and death.

The systematic review and meta-analysis that examined data from more than 14 million patients across 125 studies found that 25-50 per cent of patients with PAD are not receiving guideline-recommended medications, such as antiplatelets, statins and antihypertensives. Even when prescribed, approximately 25 per cent of patients do not follow the treatment properly, further risking severe complications. Certain groups were less likely to receive the proper treatment, including women, older adults and patients with multiple health conditions. These groups faced a higher risk of major cardiac events, limb loss and death.

The study suggests that several factors may contribute to this gap in treatment, including lack of awareness of the appropriate guideline-recommended medications among clinicians, inconsistent practices across health-care settings, and barriers faced by patients such as side effects, costs and poor communication.  

“This study underscores the urgent need for system-level interventions, including better education for health-care providers, improved patient support and strategies to ensure consistent delivery of evidence-based care,” said Dr. Derek Roberts[SO1] , study lead, associate scientist and vascular and endovascular surgeon at The Ottawa Hospital and assistant professor at the University of Ottawa. “We need to take action by closing the gap between what the guidelines recommend and what patients actually receive.”

Aidan Kirkham, study co-lead and epidemiology PhD candidate at the University of Ottawa, is also thinking about next steps. “With this study, we can build a targeted, evidence-based strategy to improve PAD care, one that can be implemented across health systems,” said Kirkham, who is co-supervised by Dr. Roberts and Dr. Dean Fergusson. “Our goal is to create a model for how guideline-based care for PAD can be delivered consistently and effectively.”

Authors: Aidan M. Kirkham, Maude Paquet, Dean A. Fergusson, Ian D. Graham, Justin Presseau, Daniel I. McIsaac, Sudhir K. Nagpal, David de Launay, Sami Aftab Abdul, Risa Shorr, Jeremy M. Grimshaw, Derek J. Roberts

Cores: Ottawa Methods Centre

Funding: Vanier Canada Graduate Scholarship, Graham Farquharson Physician Services Incorporated Knowledge Translation Fellowship, University of Ottawa Department of Surgery

The Ottawa Hospital is a leading academic health, research and learning hospital proudly affiliated with the University of Ottawa and supported by The Ottawa Hospital Foundation.