Abstract 266: Are Outpatient Cardiologists Asking about Peripheral Artery Disease Clinical Symptoms in Low and High Risk Patients in accordance with ACC/AHA Guidelines?

Abstract

Background: Lower extremity peripheral artery disease (PAD) is a common syndrome that afflicts many individuals and leads to significant morbidity. The American College of Cardiology (ACC)/American Heart Association (AHA) Guidelines for the Management of Peripheral Artery Disease (PAD) (JACC, 2006) outlines four clinical symptoms (claudication, walking impairment, exertional leg complaints and poorly healing wounds) that should be asked to at risk patients. Outpatient cardiology practices often take care of individuals at risk for PAD and have the opportunity to screen and improve quality of medical care in accordance with professional guidelines. Methods: A group of 367 outpatients seen in a large academic cardiology practice from September 2011 underwent chart review. Risk factors for PAD that were assessed include history of smoking, hypertension, diabetes, hyperlipidemia, homocysteine levels, and CRP. Those that had three or more risk factors or a previous diagnosis of known PAD were classified as high risk and those with less than 2 risk factors were classified as low risk. Documentation of whether clinical symptoms were asked was obtained from outpatient chart. Fisher exact test was utilized for statistical analysis. Results: Fifty-seven percent (N=208) of our population were classified as high risk for PAD and forty-three percent (N=158) were low risk. Table 1 below shows assessment of clinical symptoms in high and low risk patients. Conclusions: Though both high risk and low risk PAD patients are assessed at equivalent rates for clinical symptoms, the vast majority of patients overall are underassessed. Lack of knowledge of clinical symptoms can lead to underscreening of PAD and thus undertreatment. Increasing clinical symptom screening in the outpatient cardiology setting can lead to quality improvement and adherence to ACC/AHA Guidelines.