Interventions that improve evidence-based care for patients with Peripheral Artery Disease (PAD) are urgently needed. Living with PAD reduces quality of life and function, and patients risk recurrent surgeries, heart attacks, stroke, limb amputation, and death. Risk factors for PAD progression are modifiable, but only 60% of patients receive guideline-recommended medications. This poor optimisation causes disproportionately high adverse outcomes with ten-year mortality rates in PAD patients 15% higher than those without PAD, a 3-4 times higher likelihood of heart attack or stroke, and major limb amputations are mostly due to PAD.
These health inequities are contributed to by poor integration of care services, barriers in access to care, and a lack of clinician awareness. There is a recognised need for new, patient-centered, integrated, multidisciplinary care models to address the unmet need for effective secondary cardiovascular risk reduction in this high-risk cohort. Few studies have evaluated interventions to bridge the implementation gap. This evidence-to-practice gap is the focus of this PhD, aiming to evaluate a new care model to improve secondary risk modification in PAD patients.
TEAM-PAD commenced in 2024, funded by a Heart Foundation Vanguard Grant. In this multicentre, patient-level randomised controlled trial, PAD patients receive either multidisciplinary team (MDT) informed care or usual care from their vascular surgeons. The primary outcome is a change in residual 10-year cardiovascular risk between baseline and 9 months, measured by the SMART-REACH model. Secondary outcomes include major adverse cardiac and limb events (MACE, MALE), mortality, control of modifiable risk factors, and prescription of cardioprotective medications. As of now, 80 of 150 patients have completed baseline assessments, revealing a high degree of unmet needs and poor risk factor management, emphasising the study's feasibility and importance.
This doctoral research expands on clinical efficacy outcomes to evaluate program implementation and fidelity, patient-reported outcomes and experiences, health economics, and long-term sustainability in the public health system.
Last updated20 October 2025