Rethinking Lower Limb Peripheral Artery Disease Management through Digital Therapeutics: a PESTEL and SWOT/TOWS Analyses

Abstract

Background: Lower limb peripheral artery disease (PAD) is a prevalent, debilitating vascular condition associated with high morbidity, mortality, and healthcare costs. Despite established pharmacological, lifestyle, and interventional therapies, suboptimal adherence limits its effective management. Digital therapeutics (DTx) have emerged as innovative tools able to support patients in the management of their disease. Our objective was to identify the key elements for developing a DTx to prevent poor outcomes in PAD in France.

Methods: A structured review was performed using PESTEL (Political, Economic, Sociocultural, Technological, Environmental, Legal) and SWOT/TOWS (Strengths, Weaknesses, Opportunities, Threats) frameworks. This review evaluated macro-environmental drivers, systemic constraints, and implementation opportunities.

Results: The PESTEL analysis highlighted major challenges: limited preventive strategies, underdeveloped ambulatory care, shortages of healthcare professionals, complex reimbursement processes, and significant economic and environmental burdens. Opportunities included supportive policy initiatives for DTx, technological readiness for telemonitoring, and growing public interest in accessible digital solutions. The SWOT/TOWS analysis identified DTx as strategically positioned to improve adherence, facilitate outpatient pathways, reduce administrative workload, and mitigate workforce constraints. Key design features identified patient education, behavioral nudges, multimodal data inputs, and nurse-led follow-up.

Conclusions: PESTEL and SWOT/TOWS analyses provide a structured, context-specific framework for developing a PAD-focused DTx. The tool should improve adherence, reduce hospitalizations, and align with public health goals of prevention, efficiency, and sustainability. Further clinical evaluation is needed to confirm real-world value. This approach may also serve as a model for PAD-focused DTx in other countries or DTX targeting other chronic cardiovascular diseases.

Keywords: Ambulatory Care; Digital Health; Health Technology Assessment; Peripheral Arterial Disease; Review; Secondary Prevention; Treatment Adherence and Compliance.