More work needed on managing PAD, experts warn

Patients with peripheral arterial disease (PAD) may continue to be undermanaged despite updated NICE guidance on vasodilator treatment, the Primary Care Cardiovascular Society has warned.

PAD: Intermittent claudication can be painful
PAD: Intermittent claudication can be painful

Use of naftidrofuryl oxalate for painful symptoms of PAD has been backed in the latest NICE guidance.

Lifestyle changes, such as quitting smoking, healthy eating and regular exercise, are key to preventing PAD, but painful symptoms can prevent patients from exercising.

NICE has recommended naftidrofuryl for people with intermittent claudication caused by PAD.

The treatment should be considered in patients for whom vasodilator therapy is considered appropriate and after other treatment options have been taken into account.

Primary Care Cardiovascular Society president Dr Kathryn Griffith said the advice would give GPs confidence to use the drug when secondary care specialists recommended it.

But she said further work still needed to be done to improve care for all patients with peripheral vascular disease (PVD).

'PVD is a very neglected area and this advice may have little impact alongside all the other advice we are expected to follow,' she said. 'The big issue with PVD should be to manage the CVD risk rather than focus on symptoms.'

NICE said that, as well as having a detrimental impact on quality of life, intermittent claudication also indicates that there is an increased risk of heart attack and stroke.

People with intermittent claudication are also at higher risk of dying from a heart attack or stroke than patients with PAD who do not have symptoms.

Treatment should be initiated with the least expensive preparation of naftidrofuryl, the institute said.

NICE evaluated three other vasodilators as part of its appraisal: cilostazol, pentoxifylline and inositol nicotinate.

It concluded that these other drugs were not as cost effective as naftidrofuryl.

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