Peripheral Patients? PAD (peripheral arterial disease) Policy Initiative

Written by: Dr. Tony Hockley

Visiting Senior Fellow, Department of Social Policy, London School of Economics and Political Science (LSE)

LSE is developing a white paper on PAD funded by and in collaboration with AstraZeneca


It is a disease that affects around 202 million people worldwide1 and puts a significant strain on health and economic systems,2,3 yet awareness remains low and sub-optimal care is an issue.4,5,6 We are talking about peripheral arterial disease (PAD), a common circulatory problem in which narrowed arteries reduce blood flow to the limbs.7 When a patient develops PAD, their extremities — most often the legs — do not receive enough blood, which can cause symptoms including leg pain when walking.7

It may not sound all that serious, but amongst those living with symptoms of PAD, the disease adversely affects quality of life across the whole spectrum of severity.8 Studies have shown that PAD is a good marker for arterial disease and an increased risk of cardiovascular events in comparison with those not suffering from PAD.9 There are also substantial healthcare costs associated with PAD, which can also have a significant impact on individuals and their households, affecting daily activities including employment.2,3

Faced with rising demand due to demographic change, and factors such as rising obesity rates in many countries, healthcare systems must better manage conditions that become much more expensive once patients are hospitalised. From a policy standpoint it makes sense to manage PAD as early and effectively as possible. Our research so far has suggested that PAD is a prime example for improvements that could benefit patients and health systems.

With the financial support of AZ, we are now working with medical experts in PAD to compile a White Paper to identify and analyse existing policy initiatives. Our goals are to uncover information regarding the economic and human burden of the disease, define unmet needs in the disease area and better understand barriers to policy action for improved care. Once we have this vantage point, we can move on to discover ways in which barriers can be overcome. Our initial findings indicate that there is a paucity of data on what really works in the care of patients diagnosed with PAD.

We hope the White Paper will outline that, in our view, the burden of PAD can be largely reduced from a policy perspective. Across the world, healthcare systems are being strained by PAD hospitalisations that could be avoided with greater disease awareness and better coordination of care pathways.10,11 PAD is underdiagnosed and undertreated,6 despite the fact that it shares both the same underlying process for the narrowing of arteries and the same risk factors as other types of cardiovascular disease.6

A PAD expert policy roundtable sponsored by AstraZeneca and held recently in Rome reviewed these concerns. It brought together experts from eight countries to review our findings and share opinions on the current local and regional situation regarding PAD, with a view to identifying the specific challenges that need to be addressed. We hope that this will identify areas that require action from policy and clinical standpoints, to support people living with PAD and begin to transform care through collaborative global action.


  1. Mo Mozaffarian, D., Benjamin, E. J., Go, A. S., Arnett, D. K., Blaha, M. J., Cushman, M., . . . Stroke Statistics, S. (2015). Heart disease and stroke statistics--2015 update: a report from the American Heart Association. Circulation, 131(4), e29-322. doi: 10.1161/CIR.0000000000000152
  2. Marrett, E., Dibonaventura, M. D., & Zhang, Q. (2013). Burden of peripheral arterial disease in Europe and the United States: a patient survey. Health and quality of life outcomes, 11, 175. doi: 10.1186/1477-7525-11-175
  3. Hirsch, A. T., Hartman, L., Town, R. J., & Virnig, B. A. (2008). National health care costs of peripheral arterial disease in the Medicare population. Vascular medicine (London, England), 13(3), 209. doi: 10.1177/1358863X08089277
  4. McDermott, M. M., Mehta, S., Ahn, H., & Greenland, P. (1997). Atherosclerotic Risk Factors Are Less Intensively Treated in Patients with Peripheral Arterial Disease Than in Patients with Coronary Artery Disease. Journal of General Internal Medicine, 12(4), 209-215. doi: 10.1046/j.1525-1497.1997.012004209.x
  5. Smolderen, K. G., Wang, K., de Pouvourville, G., Bruggenjurgen, B., Rother, J., Zeymer, U., . . . Investigators, R. R. (2012). Two-year vascular hospitalisation rates and associated costs in patients at risk of atherothrombosis in France and Germany: highest burden for peripheral arterial disease. Eur J Vasc Endovasc Surg, 43(2), 198-207. doi: 10.1016/j.ejvs.2011.09.016
  6. AHA, AHA Conference Report: Improving Vascular Disease Prevention, Dtection and Treatment. 2015, American Heart Assocation.
  7. Mayo Clinic, Peripheral artery disease (PAD), Accessed 8/17/16.
  8. Maksimovic, M., Vlajinac, H., Marinkovic, J., Kocev, N., Voskresenski, T. & Radak, D. (2014). Health-Related Quality of Life Among Patients With Peripheral Arterial Disease. Angiology. 65(6), 501-506
  9. NICE. (2012). Lower Limb Peripheral Arterial Disease: Diagnosis and Management. Manchester: National Institute for Health and Care Excellence.
  10. Hirsch, A. T., Hartman, L., Town, R. J., & Virnig, B. A. (2008). National health care costs of peripheral arterial disease in the Medicare population. Vascular medicine (London, England), 13(3), 209. doi: 10.1177/1358863X08089277
  11. Malyar, N., Furstenberg, T., Wellmann, J., Meyborg, M., Luders, F., Gebauer, K., . . . Reinecke, H. (2013). Recent trends in morbidity and in-hospital outcomes of in-patients with peripheral arterial disease: a nationwide population-based analysis. Eur Heart J, 34(34), 2706-2714. doi: 10.1093/eurheartj/eht288