Abstract
BackgroundPeripheral arterial disease (PAD) is a marker of systemic atherosclerosis and associated with a three to six fold increased risk of death from cardiovascular causes. Furthermore, it is typically asymptomatic and under-diagnosed; this has resulted in escalating calls for the instigation of Primary Care PAD screening via Ankle Brachial Index (ABI) measurement. However, there is limited evidence regarding the feasibility of this and if the requisite core skills and knowledge for such a task already exist within primary care. This study aimed to determine the current utility of ABI measurement in general practices across Wales, with consideration of the implications for its use as a cardiovascular risk screening tool.MethodA self-reporting questionnaire was distributed to all 478 General Practices within Wales, sent via their responsible Health Boards.ResultsThe survey response rate was 20%. ABI measurement is primarily performed by nurses (93%) for the purpose of wound management (90%). It is infrequently (73% < 4 times per month) and often incorrectly used (42% out of compliance with current ABI guidance). Only 52% of general practitioners and 16% of nurses reported that patients with an ABI of ≤ 0.9 require aggressive cardiovascular disease risk factor modification (as recommended by current national and international guidelines).ConclusionABI measurement is an under-utilised and often incorrectly performed procedure in the surveyed general practices. Prior to its potential adoption as a formalised screening tool for cardiovascular disease, there is a need for a robust training programme with standardised methodology in order to optimise accuracy and consistency of results. The significance of a diagnosis of PAD, in terms of associated increased cardiovascular risk and the necessary risk factor modification, needs to be highlighted.
Highlights
Peripheral arterial disease (PAD) is a marker of systemic atherosclerosis and associated with a three to six fold increased risk of death from cardiovascular causes
52% of general practitioners and 16% of nurses reported that patients with an Ankle Brachial Index (ABI) of ≤ 0.9 require aggressive cardiovascular disease risk factor modification
PAD can be diagnosed and quantified by means of the ankle brachial index (ABI) which involves a comparison of the systolic pressure at the ankle with the systolic pressure at the arm; an ABI of ≤0.9 is considered diagnostic of the disease
Summary
Peripheral arterial disease (PAD) is a marker of systemic atherosclerosis and associated with a three to six fold increased risk of death from cardiovascular causes. It is typically asymptomatic and under-diagnosed; this has resulted in escalating calls for the instigation of Primary Care PAD screening via Ankle Brachial Index (ABI) measurement. PAD is typically asymptomatic and under-diagnosed [3] This has resulted in calls for the instigation of Primary Care PAD screening which would identify those at increased risk and potentially allow alteration of the disease trajectory via secondary risk factor modification [4]. The Scottish Intercollegiate Guidelines Network (SIGN) state that there is a pool of expertise for measuring the ABI of patients in the community but they do not substantiate this and existing research regarding this issue has produced varying results [7]
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