Abstract 4364177: Underutilization of Palliative Care in Peripheral Artery Disease: A State-of-the-Art Review Across Cardiovascular Conditions

Abstract

Introduction: Peripheral artery disease (PAD) is associated with high morbidity and mortality, yet palliative care (PC), a supportive, team-based approach integrated remains underutilized. This review contrasted PC components, patient-level and program outcomes, and patient-reported outcomes across heart failure (HF), coronary artery disease (CAD), and peripheral artery disease (PAD). Methods: We searched PubMed and Cochrane databases for English-language studies published from January 1, 2014, to December 19, 2024. Studies included systematic reviews and original investigations of PC interventions in HF, CAD, and PAD. The ROBIS tool was used for quality appraisal. Data were synthesized across seven domains: (1) symptom management, (2) advance care planning (ACP), (3) psychosocial/spiritual support, (4) quality-of-life measurement (QoL), (5) interdisciplinary team integration, (6) referral timing and triggers, and (7) sustainability of care. Results: Fifty-six studies were included (HF: n=48; PAD: n=5; CAD: n=2; HF+CAD: n=1), including randomized trials, meta-analyses, and observational studies. HF studies focused on patients with New York Heart Association (NYHA) Class II–IV and high comorbidity burden, across in- and outpatient settings. PAD studies included patients with chronic limb-threatening ischemia; CAD populations were post-MI or post-revascularization. HF programs used validated QoL tools (e.g., ESAS, KCCQ, EQ-5D) to guide symptom management and referrals. ACP was a central feature of HF interventions, contributing to improved documentation, reduced hospital utilization, and care alignment. In contrast, PAD studies mostly lacked standardized assessment tools and relied on clinical outcomes (e.g., readmissions, complications, mortality). ACP was limited to end-of-life contexts without continuity. Psychosocial and spiritual support services were rarely addressed. CAD studies utilized general and disease-specific QoL instruments (SF-36, Seattle Angina Questionnaire), and focused on education and rehabilitation with minimal PC integration. ACP was rarely emphasized, psychosocial/spiritual support was excluded, and PC referrals for CAD patients were late and lacked continuity. Conclusion: HF programs provide a transferable template for PAD, based on an early, structured and multidisciplinary PC. This could lead to a PAD-specific care model that integrates best practices from HF and that helps address underuse in a vulnerable and overlooked population.