An Audit of Primary Care Referral for Peripheral Arterial DiseaseA Missed Opportunity for Early Intervention

Introduction: Symptomatic peripheral arterial disease (PAD), either claudication or chronic limb-threatening ischaemia (CLTI), is a common cause for vascular surgery referral. Best medical therapy (BMT), encompassing anti-platelet therapy, statins, smoking cessation, blood pressure and glycaemic control, is a cornerstone of PAD management. We have noticed these easily-modifable risk factors are often left unaddressed by GPs at time of referral. Methods: A random selection of electronic referrals by GPs to the vascular department for symptomatic PAD between between July 2021-March 2022 were audited prospectively. Referrals were individually reviewed for demographic characteristics, referral indication, medical history, smoking status and current medications. Data was analysed using Microsoft Excel. Results: One-hundred-and-sixteen referrals were analysed. The mean age was 69.0 years (range 3594) and 67% (n = 78) were male. The typical vasculopath comorbidity profile was noted. Fifty-one percent (n = 59) were referred with claudication-type pain and 24% (n = 28) with CLTI, respectively. Seventy-nine percent of referrals (n = 92) included peripheral pulse examination findings. Twentyeight percent (n = 33) of new referrals were active smokers, while 31% (n = 36) had no smoking status documented. Regarding BMT, only 34.5% (n = 40) and 52% (n = 60) were on anti-platelets and statins, respectively. Overall, only eleven referral letters specifically mentioned discussing risk factor optimisation with patients during the consultation. Conclusions: Our frst-cycle results demonstrate a signifcant number of new PAD referrals were not receiving BMT in the community. For our intervention, we need to communicate how optimal PAD management begins in primary care and ensure GPs have sufcient knowledge to tackle these challenging, high-risk patients.