Pathways to diagnosis with peripheral artery disease: A case-note review

Peripheral artery disease (PAD) is a long-term condition describing impaired blood flow to the limbs, typically the legs. In 2019 approximately 237M people were living with PAD worldwide; however, despite its prevalence this condition is poorly recognised by patients, the public and health professionals, contributing to its underdiagnosis. This is compounded by the typical risk factors (including older age, smoking and ethnic minority group) and the many comorbidities (such as coronary artery/heart disease and diabetes) that present alongside PAD, which symptoms are often attributed to. Together these factors contribute towards a prolonged diagnostic pathway, which is in turn associated with poorer wellbeing such as increased anxiety/depression and negative physical outcomes such as ulceration and gangrene which, if left too long before medical help is sought, can lead to limb loss and amputation. 

This 6-month study, funded by an Individual Development Award from ARC KSS, will aim to quantify the length of diagnostic intervals experienced throughout the diagnostic pathway. This will be achieved through a case-note review of patients referred to the East Surrey Hospital in the last 5 years. The length between key events in the help seeking pathway (including what dates patients were seen, by whom and where; what tests were conducted and when; and when treatment was started) will be mapped to the Model of Pathways to Treatment (MPT). This is a theoretical framework used to understand events, processes and intervals that lead to diagnosis and the start of treatment for a health concern. Our rapid review (Clothier, Armes, Heiss & Harris; submitted) explored diagnostic intervals using this framework and found there is poor understanding and a lack of research into this at present. The present study aims to bridge this gap helping to elucidate the diagnostic pathway for PAD. By better understanding where prolonged intervals in the diagnostic pathway arise it is hoped that these can be specifically addressed, leading to more timely diagnosis with PAD and ultimately improving the lives of those living with this condition.