Peripheral arterial disease: adverse impacts, disparities in outcomes, and the path ahead

This is the third paper in the peripheral arterial disease (PAD) Series. The first and second papers in this Series outline that PAD affects over 300 million people worldwide and can be diagnosed by non-invasive tests, as well as that treatment requires medications to reduce modifiable risk factors and that exercise therapy and revascularisation are required in selected patients. In this paper, the devastating effects of PAD at the individual level are described, including chronic pain, functional limitation, loss of independence, impaired physical and mental quality of life, unemployment, and financial instability. Individuals with PAD are also at high risk of major adverse events, including major amputation, myocardial infarction, stroke, and death. The burden of PAD falls heavily on underserved groups, including women, First Nations Peoples globally, other non-White individuals, patients with financial insecurities, and those living in remote areas. Recommendations to advance PAD management are presented and include short-term changes, such as improving disease awareness and introducing multidisciplinary models of care that deliver more holistic medical and rehabilitation care, as well as long-term changes, such as testing whether screening and initiation of early medical management can reduce the burden of PAD. Furthermore, modification of health-care services is needed to provide better access for underserved, rural and remote, First Nations, and low-income populations.