Cardiovascular Risk Assessment and Rehabilitation in Adults Using Lower-Limb Prostheses: An Interdisciplinary Approach Integrating Cardiac Technology, Nursing, Clinical Nutrition, and Prosthetic-Orthotic Care

Background: Adults with lower-limb prostheses comprise heterogeneous groups, including people with dysvascular amputation related to peripheral artery disease (PAD) or diabetes and people with traumatic limb loss. In dysvascular populations, cardiovascular disease and mobility limitations coexist, while prosthetic walking can impose a relatively high energetic demand. Cardiovascular prevention and prosthetic rehabilitation are often considered in different clinical pathways [1–7]. Research problem: Although cardiology and amputation-rehabilitation guidelines address their respective domains, evidence is limited on how to coordinate cardiovascular risk assessment, symptom-triggered catheterization or electrophysiology services, nursing continuity, nutritional care, and prosthetic-orthotic management for adults using lower-limb prostheses. Aim: To critically synthesize clinically relevant evidence and propose a risk-stratified interdisciplinary pathway linking cardiovascular safety with functional recovery, while distinguishing established recommendations from untested service-design proposals. Methods: A focused, non-systematic narrative synthesis of published systematic reviews, clinical studies, guidelines and service standards relevant to lower-limb amputation, cardiovascular disease, rehabilitation, nutrition and prosthetic mobility. Bibliographic details were checked against publisher or bibliographic records when accessible. No formal exhaustive screening, meta-analysis, evidence grading or original patient-data collection was undertaken. Synthesis: Cardiovascular comorbidity is associated with less favorable prosthetic mobility in observational evidence, and the energy cost of walking differs across amputation levels and causes [3,4]. Contemporary dysvascular cohorts show substantial competing mortality and mobility burdens and inconsistent outcome reporting [23,24]. Selected exercise interventions improve walking-related function, although confidence for cardiorespiratory endpoints is weaker [5,29]. Existing guidelines support individualized cardiovascular prevention and prosthetic rehabilitation; direct trials testing the complete interdisciplinary pathway remain lacking [1,2,8,9,20]. Conclusion: A practical pathway should link medical risk stratification, prosthetic assessment, graded function-focused exercise, nurse-led transitions, and individualized nutrition. Catheterization and electrophysiology teams should participate when standard clinical indications arise. This proposed model is not yet validated as a single intervention and warrants prospective testing.