H.J.P Fokkenrood

Innovative strategies for
intermittent claudication

towards a stepped care approach and new outcome measures

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INTRODUCTION


 In the near future, the increasingly unaffordable health care costs in Europe (from 13% of national income in 2012 to 31% in 2040 in the Netherlands, comparable for other European countries), necessitates a more economically viable and efficient healthcare.1 In a recently released document titled "Healthcare, how much is it worth?" the Dutch ministry of health, welfare and sport notes several reasons for this increase.1 The aging population explains 25% of this rise, while a larger amount is clarified by the growth in prosperity including the introduction of new technologies, change of expectations of healthcare in society and increasing life expectancies. Additionally the change in epidemiologic factors, causing an increase in patients with chronic diseases, will lead to a rise in demand for healthcare, again resulting in a rise of costs. These changes in society and its influence on healthcare are well reflected in peripheral arterial occlusive disease (PAOD). PAOD is a chronic systemic disease caused by the manifestation of atherosclerosis. The atherosclerotic process of narrowing and hardening of arteries can occur in each artery of the human body although it mainly affects coronary, cerebral and peripheral arteries (especially those in the lower extremities).2 PAOD has a high prevalence in the general population affecting up to 20% in persons over 70 years.3 These numbers indicate that PAOD affects over 27 million individuals in North America and Europe.2 The manifestation of PAOD varies from absence of symptoms to tissue loss that may eventually require amputation of an affected limb. PAOD patients commonly present with symptoms of typical intermittent claudication (IC, which means 'to limp') in 20-50% of the cases.2 IC is defined as muscle discomfort in the lower limb elicited by exercise and relieved by rest within 10 minutes.2 IC has a significant impact on quality of life. New insights to optimize PAOD (IC) treatment are based on non-invasive conservative as well as (minimal) invasive strategies. However, restructuring the provided healthcare system might support an efficient PAOD treatment even more. The aim of this article is to introduce an innovative treatment model based on the WHO chronic care framework in combination with an optimized multidisciplinary healthcare chain and the implementation of innovative eHealth & mHealth technologies.