Improving healthcare for people with peripheral artery diseases.

Question: How can we best deliver holistic care for people with peripheral arterial disease (PAD) and abdominal aortic aneurysm (AAA) internationally? Background: People with PAD or AAA, the commonest peripheral arterial diseases, are the highest cardiovascular-risk groups globally. Only 20% of them, however, receive guideline-compliant risk-factor care, as healthcare-systems internationally mostly focus on late-stage PAD/AAA surgery rather than prevention or addressing risk-factors. This is the main problem regarding vascular-care worldwide, leading to preventable deaths, amputations, cardiovascular-events, and higher care-costs. Enabling me to develop my team, resources, and infrastructure, this Professorship will be instrumental in resolving this multifactorial-problem. I delivered several NIHR awards during my NIHR Advanced Fellowship, developing early clinical-interventions for people with PAD (CHABLIS study) or AAA (CRISP study). These support lifestyle-changes and prescribing using checklists, documents, software for patients and healthcare-professionals (HCPs). Patients and HCPs asked that these interventions should be expanded and combined into a simple tool for all PAD/AAA sufferers, addressing their risk-factors using guidelines. This led to the CIRCULIFE intervention idea, my Professorship's core research-focus. Overarching research-aim: Finalise and implement a flexible clinical-intervention (CIRCULIFE) optimising cardiovascular-care for PAD/AAA sufferers, also acting as my Professorship's development vehicle. I will expand/establish global collaborations/infrastructure to address the main issue impacting vascular-care worldwide, developing my leadership in vascular intervention development/testing, complex-trials, and team-science. Objectives: Update the evidence base for the proposed work and create an international evolving dataset for PAD/AAA Set up lay/expert groups, collaborations, and a global Vascular Applied Research and Innovation Centre (VARIC) Update, adapt, combine my preliminary clinical-interventions into a single intervention for PAD/AAA, focussing on key elements that improve the lives of people with PAD/AAA: lifestyle-changes, medication-use, streamlined care-provision. This will be called CIRCULIFE: 'Comprehensive Intervention for Circulatory System Disorders to Improve the Life of Patients'. Tools for better exercise-uptake/weight-loss via my ongoing NIHR work will supplement CIRCULIFE Feasibility-test CIRCULIFE and adapt it for other healthcare-systems in Europe, USA, Australasia Design and fund an international cluster randomised controlled trial (RCT) assessing CIRCULIFE clinical/cost-effectiveness Complete my training/development package, becoming a global-leader in vascular clinical-interventions and trials. Methods: Using co-creation, intervention-mapping, qualitative/quantitative data and findings from CRISP/CHABLIS, I will develop CIRCULIFE with lay/expert groups. After refinement, I will design a cluster trial to guide wide-scale adoption, supported by two clinical trials units across several countries with similar healthcare pathways, whilst instituting a Vascular Applied Research and Innovation Centre in Leicester. This will establish me as a global leader in arterial disease research, helping design/deliver research addressing the complex needs of vascular patients before, during, and after surgery. PPIE: This work was designed with 124 patients and 103 HCPs (surveys, workshops, conferences). A James Lind Alliance Priority Setting Partnership with 122 patients identified all areas of the work as key vascular-research priorities. Four lay co-applicants and an advisory group supported by a PPI/equality diversity inclusivity (EDI) lead, will support me. Dissemination: Frequent updates will be prepared by lay co-applicants and PPI advisory-group. Annual dissemination-events will publicise progress. Findings will be shared open-access and through videos, a website, infographics.