Implementation science in vascular medicine: Translating research findings into everyday practice

The interdisciplinary field of implementation science bridges the gap between research and practice in healthcare by promoting the systematic uptake of evidence-based interventions into routine clinical settings. Unlike traditional research, which often stops at discovering what works, implementation science delves into how, why, and to what extent interventions can be effectively integrated within specific contexts. It seeks to understand and improve the adoption, fidelity, and sustainability of healthcare innovations, ensuring that the benefits of an evidence-based practice reach patients more efficiently and equitably. Given the alarming inadequacy of guideline-concordant care across nearly every field of medicine, implementation science efforts are needed now more than ever.

A cornerstone of implementation science is the focus on evidence-based practices. This involves identifying interventions that have been scientifically validated (usually in clinical guidelines or protocols) and systematically ensuring their application in practice settings. Examples from the field of vascular medicine include the use of statin and antithrombotic medications along with tobacco cessation for patients with peripheral artery disease (PAD) and pretest probability scores for acute pulmonary embolism to determine when imaging is needed.^1–3

To many, the implementation science process may sound similar to quality improvement efforts in many hospitals and health systems. However, implementation science is distinct from quality improvement, although the two are often interrelated. A primary difference lies in the use of behavior change theory. Implementation science uses theoretical frameworks to guide the design, analysis, and interpretation of implementation efforts. ⁴ Doing so provides a structured understanding of the underlying mechanisms at play. It also increases the likelihood that an implementation effort will successfully change behavior and increase the use of an evidence-based practice. Furthermore, quality improvement efforts tend to focus on local improvements within specific settings (e.g., clinic, hospital ward, operating rooms), whereas implementation science aims to understand how practice change can be generalized across different contexts or clinical settings (e.g., multiple hospitals, diverse populations, and different specialties). This involves studying adaptations and modifications made to interventions or processes, which can offer insights into which elements are essential for success and which can be tailored without compromising effectiveness.

In the field of vascular medicine, there is a substantial need to develop implementation science-informed interventions to improve clinical care. It has been well documented that PAD is grossly underdiagnosed and undertreated.^5,6 This is true for both the use of guideline-concordant medications (e.g., statins, antithrombotic medications) and limb-saving interventions. Even more concerning is the significant healthcare disparity in PAD diagnosis and treatment according to geography, socioeconomic status, and race/ethnicity in the United States. On the venous side, there are also significant gaps in evidence-based care. These include sex-based differences in the use of imaging tests, overuse of hospitalization for patients with low-risk pulmonary embolism, and high rates of off-label use of anticoagulant therapy.^7–9 Implementation science offers important insights into how each of these could be addressed with the goal of improving care for individual patients and the population at large.

In the 2025 focused issue of Vascular Medicine, various opportunities, challenges, and successes of implementation efforts to improve vascular care are described. Most of these focus on the care of patients with PAD, which is reasonable given the widely documented lack of guideline-concordant care and striking inequities for this disease. For example, Nair and colleagues report that across 174 randomized clinical trials of patients with PAD between 2000 and 2022, race and ethnicity were reported in only 64% and 28%, respectively. ¹⁰ These shockingly low numbers raise questions about how well we can apply the evidence generated in a randomized clinical trial to a general population through implementation science efforts.

Other articles in this issue highlight specific steps necessary to prepare for an implementation intervention, including a thorough qualitative analysis of patients, caregivers, healthcare professionals, and other healthcare staff. A survey by Reilly and colleagues found that over one in four patients with PAD were assessed to have low ‘activation’ levels regarding engagement with their PAD care, and this state was strongly associated with lower levels of PAD-specific knowledge. ¹¹ Alabi and colleagues identified a similar deficiency in patient knowledge about PAD using semi-structured interviews, noting gaps in their patients’ ability to recall specific medications or their therapeutic intent. ¹² Collectively, these studies emphasize the necessity of addressing patient-specific barriers in conjunction with clinician- and system-level barriers to evidence-based PAD care.

Considering the widespread underdiagnosis of PAD, it is essential that improvement efforts utilize reliable methods to identify patients with PAD for their inclusion in intervention programs and for impact monitoring. Parsons and colleagues created and validated an algorithm for detecting PAD within the electronic health record using billing codes, noting an accuracy of about 80% for patients with and without chronic kidney disease. ¹³

Evidence-based interventions must frequently be adapted to better fit the needs or available resources in a given population or health system. Sivagangan and colleagues summarized the evidence supporting a technology-based adaptation to track activity for patients with PAD undergoing traditional supervised exercise therapy and home-based exercise therapy. ¹⁴ This study reviewed 15 randomized trials and three observational studies that collectively found similar improvements in walking parameters (e.g., 6-minute walk distance) and quality of life between the device-based tracking technology and usual care in both supervised and home-based exercise interventions. Other times, it is essential to establish in which population evidence-based intervention is likely to have an impact and what specific impact can be expected. Callegari and colleagues explored the association between guideline-recommended medications for patients with PAD who have undergone revascularization and their ability to prevent the need for reintervention. ¹⁵ Their analysis of data from the Vascular Quality Initiative (VQI) registry found that the use of statin, antiplatelet, and angiotensin-converting enzyme or angiotensin receptor blocker medications may not be sufficient to prevent reintervention in patients with high-risk PAD.

This issue of Vascular Medicine includes thoughtful and well-designed implementation efforts targeting specific aspects of PAD care. Hess and colleagues linked the use of dedicated clinical pharmacists to higher use of combination lipid-lowering therapy, which was associated with a substantially higher proportion of patients achieving guideline-recommended lipid reduction goals. ¹⁶ The pharmacist-led intervention achieved a 61% reduction in low-density lipoprotein cholesterol (LDL-C) from baseline to 12 months. This was driven largely by the use of combination lipid-lowering therapy, where 78% were able to achieve LDL-C levels < 55 mg/dL compared to just 18% when statin monotherapy was initiated. The next step in implementation is to study how this care model can be replicated, adapted, and sustained in a variety of different care settings with different levels of available resources.

In summary, the field of vascular medicine is ripe with opportunities to improve evidence-based care delivery. By bringing together multidisciplinary teams and incorporating specific implementation science processes and strategies, we can collectively improve clinical care for our patients. Doing so will have profound effects on population-based outcomes and may even improve the experience for clinicians and other healthcare workers.