Primary care screening for peripheral arterial disease: a cross-sectional observational study

Davies, Jane; Richards, J. R.; Conway, K. M.; Kenkre, Joyce; Lewis, Jane; Williams, Edgar M.

doi:10.3399/bjgp17x689137

Cited by 18 publications

(23 citation statements)

References 27 publications

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“…This scale includes additional risk factors such as ethnic origin, family history and the level of social exclusion. A recent study [ 40 ] undertaken in a population registered in primary care centers in Wales estimated that the use of the ABI does not provide a better reclassification of the calculation of risk with QRISCK2 since this scale itself can predict high cardiovascular risk in most patients with PAD. It is of note that this study was performed in only one centre with a low rate of participation (33%).…”

Section: Discussionmentioning

confidence: 99%

Contribution of the ankle-brachial index to improve the prediction of coronary risk: The ARTPER cohort

et al. 2018

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BackgroundThe different cardiovascular risk prediction scales currently available are not sufficiently sensitive.AimThe aim of the present study was to analyze the contribution of the ankle-brachial index (ABI) added to the Framingham and REGICOR risk scales for the reclassification of cardiovascular risk after a 9-year follow up of a Mediterranean population with low cardiovascular risk.Design and settingA population-based prospective cohort study was performed in the province of Barcelona, Spain.MethodA total of 3,786 subjects >49 years were recruited from 2006–2008. Baseline ABI was performed and cardiovascular risk was calculated with the Framingham and REGICOR scales. The participants were followed until November 2016 by telephone and review of the clinical history every 6 months to confirm the possible appearance of cardiovascular events.Results2,716 individuals participated in the study. There were 126 incidental cases of first coronary events (5%) during follow up. The incidence of coronary events in patients with ABI <0.9 was 4-fold greater than that of subjects with a normal ABI (17.2/1,000 persons-year versus 4.8/1,000 persons-year). Improvement in the predictive capacity of REGICOR scale was observed on including ABI in the model, obtaining a net reclassification improvement of 7% (95% confidence interval 0%-13%) for REGICOR+ ABI. Framingham + ABI obtained a NRI of 4% (-2%-11%).ConclusionThe results of the present study support the addition of the ABI as a tool to help in the reclassification of cardiovascular risk and to confirm the greater incidence of coronary events in patients with ABI < 0.9.

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Section: Discussionmentioning

confidence: 99%

Contribution of the ankle-brachial index to improve the prediction of coronary risk: The ARTPER cohort

et al. 2018

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“…20 Other studies have identified that patients with PAD symptoms delay consulting their GP. 21,22 Davies et al reported one third of patients with debilitating symptoms of intermittent claudication had not consulted their GP, 21 and suggest a need to raise public awareness of PAD. A low level of patient knowledge about PAD and its risks has been reported in the UK [21][22][23] and the Netherlands.…”

Section: Comparison With Existing Literaturementioning

confidence: 99%

“…21,22 Davies et al reported one third of patients with debilitating symptoms of intermittent claudication had not consulted their GP, 21 and suggest a need to raise public awareness of PAD. A low level of patient knowledge about PAD and its risks has been reported in the UK [21][22][23] and the Netherlands. 24 The present findings add weight to these studies, including describing additional challenges in the diagnosis and management pathways.…”

Section: Comparison With Existing Literaturementioning

confidence: 99%

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Peripheral arterial disease diagnosis and management in primary care: a qualitative study

et al. 2019

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BackgroundPatients diagnosed with peripheral arterial disease (PAD) are at an increased risk of coronary heart disease, stroke, heart attack, and PAD progression. If diagnosed early, cardiovascular risk factors can be treated and the risk of other cardiovascular diseases can be reduced. There are clear guidelines on PAD diagnosis and management, but little is known about the issues faced in primary care with regards adherence to these, and about the impact of these issues on patients.AimTo identify the issues for primary care health professionals (HPs) and patients in PAD diagnosis and management, and to explore the impact of these on HPs and PAD patients.Design & settingQualitative study conducted in a primary care setting in the North East of England. Data was collected between December 2014 and July 2017.MethodSemi-structured interviews and focus groups were conducted with PAD register patients (n = 17), practice nurses ([PNs], n = 17), district nurses (DNs], n = 20), tissue viability nurses (n = 21), and GPs (n = 21).ResultsHPs’ attitudes to PAD, difficulty accessing tests, and patient delays impacted upon diagnosis. Some HPs had a reactive approach to PAD identification. Patients lacked understanding about PAD and some reported a delay consulting their GP after the onset of PAD symptoms. After diagnosis, few were attending for regular GP follow-up.ConclusionPatient education about PAD symptoms and risks, and questioning about exercise tolerance, could address the problem of under-reporting. Annual reviews could provide an opportunity to probe for PAD symptoms and highlight those requiring further investigation. Improved information when PAD is diagnosed and, considering the propensity for patients to tolerate worsening symptoms, the introduction of annual follow-up (at minimum) is warranted.

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“…Implementing a PAD management approach (Figure ) begins with reliable, consistent screening at the earliest point of primary care, usually based on physical symptoms of PAD for those at least 50 years of age such as an ankle/brachial systolic blood pressure ratio (ABI) <0.9 or absence of pedal pulse, cool limb, walking difficulties, or pallor on elevation . Patients with such symptoms should receive immediate, appropriate referral(s) for accurate, sensitive, and specific differential diagnosis to facilitate effective treatments administered by trained professionals.…”

Section: Introductionmentioning

confidence: 99%

Peripheral arterial disease screening and diagnostic practice: A scoping review

Donohue

Adler

Bolton

2019

International Wound Journal

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Early reliable, valid screening, diagnosis, and treatment improve peripheral arterial disease outcomes, yet screening and diagnostic practices vary across settings and specialties. A scoping literature review described reliability and validity of peripheral ischaemia diagnosis or screening tools. Clinical studies in the PUBMED database January 1, 1970, to August 13, 2018, were reviewed summarising ranges of reliability and validity of peripheral ischaemia diagnostic and screening tools for patients with non-neuropathic lower leg ischaemia. Peripheral ischaemia screening and diagnostic practices varied in parameters measured such as timing, frequency, setting, ordering clinicians, degree of invasiveness, costs, definitions, and cutoff points informing clinical and referral decisions. Traditional ankle/brachial systolic blood pressure index <0.9 was a reliable, valid lower leg ischaemia screening test to trigger specialist referral for detailed diagnosis. For patients with advanced peripheral ischaemia or calcified arteries, toe-brachial index, claudication, or invasive angiographic imaging techniques that can have complications were reliable, valid screening, and diagnostic tools to inform management decisions. Ankle/brachial index testing is sufficiently reliable and valid for use during routine examinations to improve timing and consistency of peripheral ischaemia screening, triggering prompt specialist referral for more reliable, accurate Doppler, or other diagnosis to inform treatment decisions.

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Primary care screening for peripheral arterial disease: a cross-sectional observational study

Cited by 18 publications

References 27 publications

Contribution of the ankle-brachial index to improve the prediction of coronary risk: The ARTPER cohort

Contribution of the ankle-brachial index to improve the prediction of coronary risk: The ARTPER cohort

Peripheral arterial disease diagnosis and management in primary care: a qualitative study

Peripheral arterial disease screening and diagnostic practice: A scoping review

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