NICE is calling for early identification of asymptomatic and symptomatic peripheral arterial disease to help improve the care of patients with the condition.
Peripheral arterial disease (PAD) is a common condition affecting around a fifth of people over the age of 60. People with PAD are approximately 3-4 times more likely to have a cardiovascular morbidity and mortality than those without the condition, even if the disease is asymptomatic.
Despite the condition's prevalence, it is often underdiagnosed and patients with it are often undertreated, meaning they are not accessing risk reduction strategies, accurate diagnoses and appropriate treatment, which together can prevent disease progression and adverse outcomes.
To help healthcare professionals improve the outcomes of patients with PAD, NICE has produced a quality standard on the condition which consists of five measurable statements.
These include that people who have symptoms of, or who are at risk of developing PAD, are offered a clinical assessment and ankle brachial pressure index (ABPI) measurement.
NICE says that early identification of asymptomatic and symptomatic PAD means that treatment can begin earlier, potentially slowing disease progression and improving quality of life through better mobility and reduced pain.
In addition, early identification and treatment of PAD and its risk factors can reduce the risk of cardiovascular morbidity and mortality, and the need for lower limb amputation.
Primary care professionals should ensure that any comprehensive assessment includes both a clinical assessment with structured history taking, and ABPI measurement with a hand-held doppler ultrasound scan to ensure an accurate diagnosis and quantification of disease severity.
Since people with both asymptomatic and symptomatic PAD are at increased risk of mortality from cardiovascular disease, the second statement says that people with PAD should be offered an assessment for cardiovascular comorbidities and modifiable risk factors.
This can allow for evidence-based treatment, advice and support to be given to reduce risk.
Statement three covers treatment for intermittent claudication - leg pain in the calf - which is the most common initial symptom of PAD.
The statement says that people with intermittent claudication should be offered a supervised exercise programme, as this can improve walking distance and quality of life.
Since the provision of services varies across the country, NICE states there is a need for both new provision and improvement in existing care.
Further statements cover the use of imaging and angioplasty for patients with the condition.