scholarly journals Perceived Challenges to Routine Uptake of the Ankle Brachial Index within Primary Care Practice

2021 ◽  
Vol 10 (19) ◽  
pp. 4371
Author(s):  
Lily Y. C. Chiu ◽  
Muzammil H. Syed ◽  
Abdelrahman Zamzam ◽  
Ori D. Rotstein ◽  
Rawand Abdin ◽  
...  
Keyword(s):  
Primary Care ◽  
Clinical Practice ◽  
Ankle Brachial Index ◽  
Arterial Disease ◽  
Perceived Barriers ◽  
Care Practice ◽  
Greater Toronto Area ◽  
Primary Care Practitioners ◽  
Peripheral Arterial ◽  
Primary Care Practices

(1) Introduction: The ankle-brachial index (ABI) is the most widely used method of diagnosing peripheral arterial disease (PAD). However, the uptake of ABIs has been reported to be low in primary care settings across different various healthcare settings; however, this is yet to be investigated within the Canadian context. (2) Objective: Therefore, we sought to assess the rates of ABI usage as well as perceived barriers among primary care practitioners (PCPs) in Toronto, Canada. (3) Methods: A modified questionnaire was electronically sent to 257 PCPs in the Greater Toronto Area (GTA). Questions pertained to frequency, feasibility, utility, and barriers associated with ABI usage in clinical practice. Responses were collected and tallied. (4) Results: A total of 52 PCPs completed the questionnaire. 79% of PCPs did not routinely perform ABIs within their clinical practice, and 56% deemed ABI usage as unfeasible. Constraints in time and staff personnel, as well as complexity of ABI result interpretation, were cited as the major perceived barriers to ABI usage. The overwhelming majority of PCPs viewed alternative forms of diagnosis, such as a blood test for PAD, as being preferable to ABI, as such an approach would enhance diagnostic simplicity and efficiency. (5) Conclusion: ABI usage rates are poor within primary care practices in Toronto, Canada. Alternative approaches for diagnosing PAD may result in greater adoption rates among PCPs and therefore improve the identification of patients with PAD.

scholarly journals Prevalence and predictors of peripheral arterial disease determined by ankle brachial index in diabetes population treated within primary care services in a non-urban area of lower northern Thailand

2020 ◽  
Vol 17 (6) ◽  
pp. 147916412096699
Author(s):  
Preaw Suwannasrisuk ◽  
Sarinya Sattanon ◽  
Watcharaporn Taburee ◽  
Pantitra Singkheaw ◽  
Non Sowanna ◽  
...  
Keyword(s):  
Risk Factors ◽  
Type 2 Diabetes ◽  
Primary Care ◽  
Peripheral Arterial Disease ◽  
Ankle Brachial Index ◽  
Arterial Disease ◽  
University Hospital ◽  
Peripheral Arterial ◽  
Diabetes Patients

In diabetes patients, urban lifestyle has been concerned as one of the risk factors for peripheral arterial disease (PAD). The aims of this study were to find out the prevalence and associated risk factors of PAD in type 2 diabetes patients who live in a non-urban community area. A total of 885 participants with type 2 diabetes mellitus were enrolled from six primary care units in the health network centered at Naresuan University Hospital, Phitsanulok, between May and June 2018. Ankle-brachial index (ABI) was performed in all subjects using a vascular screening device. PAD was defined by an ABI value of 0.9 or lesser at least on one leg. The predictors of PAD were analyzed using multiple logistic regression. The prevalence of PAD was 7.2% among 884 evaluable patients. Diabetic neuropathy and a history of macrovascular complications were significant predictors of PAD.

scholarly journals Survival analysis of 219 dogs with hyperadrenocorticism attending primary care practice in England

2019 ◽  
Vol 186 (11) ◽  
pp. 348-348 ◽  
Author(s):  
Imogen Schofield ◽  
David C Brodbelt ◽  
Anna R L Wilson ◽  
Stijn Niessen ◽  
David Church ◽  
...  
Keyword(s):  
Primary Care ◽  
Primary Care Practice ◽  
Multivariable Analysis ◽  
Care Practice ◽  
Electronic Patient Records ◽  
Kaplan Meier ◽  
All Cause Mortality ◽  
Cox Proportional Hazard Regression ◽  
Primary Care Practitioners ◽  
Primary Care Practices

BackgroundHyperadrenocorticism is an endocrine disease routinely encountered within primary care practice; however, few studies evaluating survival beyond diagnosis have studied this population.MethodsThis retrospective cohort study analysed the electronic patient records of 219 cases of hyperadrenocorticism from a sample of dogs attending primary care practices in England. Kaplan-Meier plots examined the cumulative survival and Cox proportional hazard regression modelling identified factors associated with the hazard of all-cause mortality.ResultsIn the analysis, 179/219 (81.7 per cent) hyperadrenocorticism cases died during the study period with a median survival time from first diagnosis of 510 days (95% CI 412 to 618 days). Trilostane was used in 94.1 per cent of cases and differentiation between pituitary-dependent and adrenal-dependent disease was made in 20.1 per cent of cases. In the multivariable analysis, dogs weighing greater than or equal to 15 kg (HR 1.51, 95% CI 1.06 to 2.15, P=0.023) and those diagnosed greater than or equal to 13 years of age (HR 3.74, 95% CI 2.29 to 6.09, P<0.001) had increased hazards of all-cause mortality. Dogs that had their initial trilostane dose increased had a favourable prognosis (HR 0.49, 95% CI 0.32 to 0.76, P=0.015).ConclusionThis study shows that survival from diagnosis of hyperadrenocorticism appears fair for many dogs and provides primary care practitioners with relatable benchmark prognostic figures.

scholarly journals Limited Adherence to Peripheral Arterial Disease Guidelines and Suboptimal Ankle Brachial Index Reliability in Dutch Primary Care

2018 ◽  
Vol 68 (1) ◽  
pp. 312
Author(s):  
D. Hageman ◽  
N. Pesser ◽  
L.N.M. Gommans ◽  
E.M. Willigendael ◽  
M.R.H.M. van Sambeek ◽  
...  
Keyword(s):  
Primary Care ◽  
Peripheral Arterial Disease ◽  
Ankle Brachial Index ◽  
Arterial Disease ◽  
Peripheral Arterial

scholarly journals How to Interpret the Ankle-brachial Index for Diagnosis of Peripheral Arterial Disease in Clinical Practice

2018 ◽  
Vol 58 (4) ◽  
pp. 47-53
Author(s):  
Masumi Matsuda ◽  
Kei Sato ◽  
Tadafumi Sugimoto ◽  
Hidetomo Onuma ◽  
Makoto Morimoto ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Peripheral Arterial Disease ◽  
Ankle Brachial Index ◽  
Arterial Disease ◽  
Peripheral Arterial

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

2017 ◽  
Vol 67 (655) ◽  
pp. e103-e110 ◽  
Author(s):  
Jane H Davies ◽  
Jonathan Richards ◽  
Kevin Conway ◽  
Joyce E Kenkre ◽  
Jane EA Lewis ◽  
...  
Keyword(s):  
Primary Care ◽  
Observational Study ◽  
Peripheral Arterial Disease ◽  
Public Awareness ◽  
Ankle Brachial Index ◽  
Arterial Disease ◽  
Smoking History ◽  
Cross Sectional ◽  
Number Needed To Screen ◽  
Peripheral Arterial

BackgroundEarly identification of peripheral arterial disease (PAD) and subsequent instigation of risk modification strategies could minimise disease progression and reduce overall risk of cardiovascular (CV) mortality. However, the feasibility and value of primary care PAD screening is uncertain.AimThis study (the PIPETTE study — Peripheral arterial disease In Primary carE: Targeted screening and subsequenT managEment) aimed to determine the value of a proposed primary care PAD screening strategy. Outcomes assessed were: prevalence of PAD and agreement of ankle– brachial index (ABI)-defined PAD (ABI ≤0.9) with QRISK®2-defined high CV risk (≥20).Design and settingA cross-sectional observational study was undertaken in a large general practice in Merthyr Tydfil, Wales.MethodIn total, 1101 individuals with ≥2 pre-identified CV risk factors but no known CV disease or diabetes were invited to participate. Participants underwent ABI measurement and QRISK2 assessment, and completed Edinburgh Claudication Questionnaires.ResultsA total of 368 people participated in the study (participation rate: 33%). Prevalence of PAD was 3% (n = 12). The number needed to screen (NNS) to detect one new case of PAD was 31. Refining the study population to those aged ≥50 years with a smoking history reduced the NNS to 14, while still identifying 100% of PAD cases. Of participants with PAD, 33% reported severe lifestyle-limiting symptoms of intermittent claudication that warranted subsequent endovascular intervention, yet had not previously presented to their GP. The QRISK2 score predicted high CV risk in 92% of participants with PAD.ConclusionThe low PAD yield and the fact that QRISK2 was largely comparable to the ABI in predicting high CV risk suggests that routine PAD screening may be unwarranted. Instead, strategies to improve public awareness of PAD are needed.

scholarly journals Limited Adherence to Peripheral Arterial Disease Guidelines and Suboptimal Ankle Brachial Index Reliability in Dutch Primary Care

2018 ◽  
Vol 55 (6) ◽  
pp. 867-873 ◽  
Author(s):  
David Hageman ◽  
Niels Pesser ◽  
Lindy N.M. Gommans ◽  
Edith M. Willigendael ◽  
Marc R.H.M. van Sambeek ◽  
...  
Keyword(s):  
Primary Care ◽  
Peripheral Arterial Disease ◽  
Ankle Brachial Index ◽  
Arterial Disease ◽  
Peripheral Arterial

scholarly journals Peripheral artery disease – necessary steps for keeping us walking

2015 ◽  
Vol 10 (3) ◽  
pp. 240-245
Author(s):  
Camelia DIACONU ◽  
◽  
Irina CRÎȘMARU ◽  
Giorgiana DEDIU ◽  
Alice BĂLĂCEANU ◽  
...  
Keyword(s):  
Heart Failure ◽  
Primary Care ◽  
Smoking Cessation ◽  
Screening Tool ◽  
Ankle Brachial Index ◽  
Arterial Disease ◽  
Common Symptom ◽  
Peripheral Artery ◽  
Artery Disease ◽  
Peripheral Arterial

Peripheral arterial disease (PAD) is a consequence of the atherosclerosis of large arteries located distal to aortic arch. The most common symptom is intermittent claudication. The most commonly used screening tool of BAP in primary care is the ankle-brachial index (ABI), especially recommended for patients older than 70 years or between 50-69 years, if they are diabetics or smokers. Management of PAD include smoking cessation, exercise, treatment with statins, antiplatelet therapy with aspirin and clopidogrel, possibly cilostazol in patients without heart failure. Surgery is recommended for patients who do not respond to drug therapy.

High tolerance of progressive elastic compression in peripheral arterial disease

VASA ◽  
2019 ◽  
Vol 48 (5) ◽  
pp. 413-417 ◽  
Author(s):  
Serge Couzan ◽  
Jean-François Pouget ◽  
Claire Le Hello ◽  
Céline Chapelle ◽  
Silvy Laporte ◽  
...  
Keyword(s):  
Venous Insufficiency ◽  
Ankle Brachial Index ◽  
Arterial Disease ◽  
Return Flow ◽  
High Tolerance ◽  
Compression Stockings ◽  
Short Term ◽  
Poor Tolerance ◽  
The Mean ◽  
Peripheral Arterial

Summary. Background: Theoretically progressive compression stockings, which produce a higher compression at the calf than at the ankle level, improve venous return flow without exacerbating peripheral arterial insufficiency (PAD). We aimed to evaluate the short-term tolerance of elastic progressive compression stockings on peripheral arterial vascularisation in patients with symptomatic PAD and associated mild venous insufficiency. Patients and methods: Monocentric, prospective, open pilot study of 18 patients (acceptability study, 6 x 6 plan) evaluating the short-term tolerance of progressive compression stockings (18 ± 2 mmHg at calf and 8 ± 2 mmHg at ankle level) in patients with PAD (ankle brachial index ABI > 0.60 < 0.75) and chronic venous insufficiency (C1s–C4 stages of the CEAP classification). Day 15 tolerance was evaluated by a composite primary criteria comprising: no decrease > 15 % of ABI on each side, no decrease > 15 % of toe brachial index (TBI) on each side and no decrease > 25 % of the number of active plantar flexions performed while standing. Results: The proportion of men was 77.8 %, mean age was 77.3 ± 7.5 years and no patient were diabetic. At inclusion, the mean low ABI was 0.60 ± 0.04 and the mean high ABI was 0.77 ± 0.18. The mean low TBI was 0.32 ± 0.09 and the mean high TBI 0.46 ± 0.15. The mean number of active standing plantar flexions was 33.0 ± 5.0. The majority of the patients were classified in CEAP C2s and C3 classes (class 2: 16.7 %, class C2s: 27.8 %, class C3: 44.4 %, class C4: 5.6 % and class C4s: 5.6 %). Poor tolerance occurred in no patient. By day 30, no patient had worsening of their arterial and venous symptoms. No adverse events occurred during the study. Conclusions: These results suggest a high tolerance of progressive elastic stockings (18 ± 2 mmHg at calf and 8 ± 2 mmHg at ankle level) in symptomatic PAD.

Predictive value of the ankle brachial index in patients with acute ischemic stroke

VASA ◽  
2014 ◽  
Vol 43 (1) ◽  
pp. 55-61 ◽  
Author(s):  
Konstantinos Tziomalos ◽  
Vasilios Giampatzis ◽  
Stella Bouziana ◽  
Athinodoros Pavlidis ◽  
Marianna Spanou ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Hospital Mortality ◽  
Acute Ischemic Stroke ◽  
Ankle Brachial Index ◽  
Arterial Disease ◽  
National Institutes Of Health ◽  
Limited Data ◽  
Severe Stroke ◽  
Hospital Outcome ◽  
Peripheral Arterial

Background: Peripheral arterial disease (PAD) is frequently present in patients with acute ischemic stroke. However, there are limited data regarding the association between ankle brachial index (ABI) ≤ 0.90 (which is diagnostic of PAD) or > 1.40 (suggesting calcified arteries) and the severity of stroke and in-hospital outcome in this population. We aimed to evaluate these associations in patients with acute ischemic stroke. Patients and methods: We prospectively studied 342 consecutive patients admitted for acute ischemic stroke (37.4 % males, mean age 78.8 ± 6.4 years). The severity of stroke was assessed with the National Institutes of Health Stroke Scale (NIHSS)and the modified Rankin scale (mRS) at admission. The outcome was assessed with the mRS and dependency (mRS 2 - 5) at discharge and in-hospital mortality. Results: An ABI ≤ 0.90 was present in 24.6 % of the patients whereas 68.1 % had ABI 0.91 - 1.40 and 7.3 % had ABI > 1.40. At admission, the NIHSS score did not differ between the 3 groups (10.4 ± 10.6, 8.3 ± 9.3 and 9.3 ± 9.4, respectively). The mRS score was also comparable in the 3 groups (3.6 ± 1.7, 3.1 ± 1.8 and 3.5 ± 2.3, respectively). At discharge, the mRS score did not differ between the 3 groups (2.9 ± 2.2, 2.3 ± 2.1 and 2.7 ± 2.5, respectively) and dependency rates were also comparable (59.5, 47.6 and 53.3 %, respectively). In-hospital mortality was almost two-times higher in patients with ABI ≤ 0.90 than in patients with ABI 0.91 - 1.40 or > 1.40 but this difference was not significant (10.9, 6.6 and 6.3 %, respectively). Conclusions: An ABI ≤ 0.90 or > 1.40 does not appear to be associated with more severe stroke or worse in-hospital outcome in patients with acute ischemic stroke.

Sign in / Sign up

Export Citation Format

Share Document