Dr. David Armstrong is Professor of Surgery with Tenure at the University of Southern California, Keck School of Medicine. Dr. Armstrong holds a Master of Science in Tissue Repair and Wound Healing from the University of Wales College of Medicine and a PhD from the University of Manchester College of Medicine, where he was appointed Visiting Professor of Medicine. He is founder and co-Director of the Southwestern Academic Limb Salvage Alliance (SALSA).
Evidence from the latest Beyond Intervention global market research, focusing on the early stages of the vascular patient journey, suggests people with Peripheral Artery Disease (PAD) encounter more challenges receiving an accurate diagnosis than people with Coronary Artery Disease (CAD).
Peripheral Artery Disease (PAD), a chronic disorder caused by progressive narrowing of the blood vessels (arteries), impacts more than 230 million adults worldwide.1 PAD most commonly affects the arteries of the lower limbs, with blockages that restrict blood flow to the legs and feet. The disease can cause troublesome symptoms that include claudication (pain brought on by walking) as well as both pain at rest and the formation of non-healing ulcers when the condition is severe. At best, the quality of life of patients with PAD can be significantly reduced; at worst, the condition can lead to amputation and premature death.
Dr. David Armstrong, an expert in limb salvage, tissue repair and wound healing, believes there are several factors and medical technologies that could contribute to improving care for patients with PAD and potentially avert the onset of disease in the future.
The evolution of smartphones together with the popularization of telehealth and the advent of remote patient monitoring is creating more dynamic healthcare options for both patient and physician, allowing them to interact with each other beyond the walls of the doctor's office.
“I think that technology is helping consumers and patients in recognition of their symptoms, and whatever disease state they’re in like never before. We’re seeing the merger of consumer electronics and medical devices that have been on a collision course to mash-up for at least the last decade,” says Dr. Armstrong
Dr. David G. Armstrong
Professor of Surgery and Director of Limb Preservation at the USC Keck School of Medicine
This so-called “mash-up” is likely what is feeding patients’ growing appetite for medical technologies designed to meet patient needs. The 2020 Beyond Intervention survey revealed that 92% of patients think we collectively can benefit from shared health data and 72% of patients want more personalized, data-driven care2 which can be facilitated via wearables, remote monitoring or with support directly with their physicians through an online patient portal.
Given that a patient’s path to arterial diseases is often complicated by comorbidities such as diabetes, physicians are also looking to emerging technologies that have the capability of identifying patients at risk for PAD long before there is any discussion about amputation. Dr. Armstrong says, “we are now helping many of our patients with peripheral artery disease, with tissue loss, at super-high risk for limb loss, to identify potentially critical symptoms that they may not have identified themselves before they ever happen.”
Dr. Armstrong emphasizes that as exciting as the proliferation of digital health tools is, technology alone is not enough to achieve early and accurate diagnoses for patients with PAD; the new Beyond Intervention survey confirmed that patients with PAD experience significantly more difficult journeys than patients with Coronary Artery Disease (CAD)—with challenges that have the potential to delay clear diagnosis and development of a treatment path. Of patients with PAD who were surveyed, they are 87% more likely to switch doctors, 71% more likely to report ineffective treatment, and 52% more likely to be misdiagnosed than patients with CAD.3
Compared to patients with CAD, patients with PAD are:
Dr. Armstrong isn’t surprised by this and thinks the best way to address these deficiencies in care is through, what he calls, the “Toe and Flow” model—a core interdisciplinary team that includes two surgeons on one service team, surrounded by nursing and good general practitioners, dieticians, prosthetists, orthotists, nurse managers, physical therapists and occupational therapists. He believes improvements in patient management, processes and metrics are leading to better outcomes for patients and that surrounding the patient by all the people involved in every aspect of their care will lead to better communication, better treatment plans and better outcomes for the patient. “The trouble is we’ve not been managing or measuring very well in a lot of areas in medicine and surgery over the years. I’d like to think that’s improving,” says Dr. Armstrong.
Creating an interdisciplinary team starts from the ground up—Dr. Armstrong says clinicians need to “find your BFF, your best foot friend…or your ‘solemate,’ and then get with her, get with him, and stick with them…find that person that really cares about the problem that you care about. In my case, it’s about helping people move through the world and about amputation prevention. And when you find that person, or hopefully people, stick with them, nurture that, develop an interdisciplinary plan.”
Patients and their families are embracing technology, not only for personal and professional use, but also for their medical care, which is leading to greater opportunities for physicians to interact with patients where they are at, making care truly patient-centered. “What it’s allowing us now is to work with that patient, or that patient’s family, where they are. And now where they are is with information that we can harness, that they can harness…it’s just an extremely exciting time because we’re able to measure what we manage like never before.”
Dr. Armstrong is excited by technology’s ability to administer activity to patients at risk of diabetic foot ulcers and PAD and the subsequent monitoring and measurement of a patient’s activity levels that is specifically designed for and tailored to that patient. “This time, instead of a drug, we’re dosing activity. And what better than to help your patient move through the world a little better.”
Whether it be an interdisciplinary team that develops holistic treatment plans or the influence of emerging technologies that lead to early diagnosis, Dr. Armstrong says the key to improving the patient experience comes down to placing the patient at the center. “It starts with the patient. She or he is at the center of every decision that’s being made.”
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