Current utility of the ankle-brachial index (ABI) in general practice: implications for its use in cardiovascular disease screening
Identifieur interne : 002C00 ( Main/Curation ); précédent : 002B99; suivant : 002C01Current utility of the ankle-brachial index (ABI) in general practice: implications for its use in cardiovascular disease screening
Auteurs : Jane H. Davies [Royaume-Uni] ; Joyce Kenkre [Royaume-Uni] ; E Mark Williams [Royaume-Uni]Source :
- BMC Family Practice [ 1471-2296 ] ; 2014.
Abstract
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. 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.
A self-reporting questionnaire was distributed to all 478 General Practices within Wales, sent via their responsible Health Boards.
The 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).
ABI 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.
Url:
DOI: 10.1186/1471-2296-15-69
PubMed: 24742018
PubMed Central: 4021160
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Davies</name><affiliation wicri:level="1"><nlm:aff id="I1">Faculty of Life Sciences and Education, University of South Wales, Pontypridd CF37 1DL, UK</nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Faculty of Life Sciences and Education, University of South Wales, Pontypridd CF37 1DL</wicri:regionArea><wicri:noRegion>Pontypridd CF37 1DL</wicri:noRegion></affiliation></author><author><name sortKey="Kenkre, Joyce" sort="Kenkre, Joyce" uniqKey="Kenkre J" first="Joyce" last="Kenkre">Joyce Kenkre</name><affiliation wicri:level="1"><nlm:aff id="I1">Faculty of Life Sciences and Education, University of South Wales, Pontypridd CF37 1DL, UK</nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Faculty of Life Sciences and Education, University of South Wales, Pontypridd CF37 1DL</wicri:regionArea><wicri:noRegion>Pontypridd CF37 1DL</wicri:noRegion></affiliation></author><author><name sortKey="Williams, E Mark" sort="Williams, E Mark" uniqKey="Williams E" first="E Mark" last="Williams">E Mark Williams</name><affiliation wicri:level="1"><nlm:aff id="I1">Faculty of Life Sciences and Education, University of South Wales, Pontypridd CF37 1DL, UK</nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Faculty of Life Sciences and Education, University of South Wales, Pontypridd CF37 1DL</wicri:regionArea><wicri:noRegion>Pontypridd CF37 1DL</wicri:noRegion></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">24742018</idno><idno type="pmc">4021160</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4021160</idno><idno type="RBID">PMC:4021160</idno><idno type="doi">10.1186/1471-2296-15-69</idno><date when="2014">2014</date><idno type="wicri:Area/Pmc/Corpus">002A64</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">002A64</idno><idno type="wicri:Area/Pmc/Curation">002A63</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Curation">002A63</idno><idno type="wicri:Area/Pmc/Checkpoint">001C46</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Checkpoint">001C46</idno><idno type="wicri:Area/Ncbi/Merge">006584</idno><idno type="wicri:Area/Ncbi/Curation">006584</idno><idno type="wicri:Area/Ncbi/Checkpoint">006584</idno><idno type="wicri:Area/Main/Merge">002C04</idno><idno type="wicri:Area/Main/Curation">002C00</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Current utility of the ankle-brachial index (ABI) in general practice: implications for its use in cardiovascular disease screening</title><author><name sortKey="Davies, Jane H" sort="Davies, Jane H" uniqKey="Davies J" first="Jane H" last="Davies">Jane H. Davies</name><affiliation wicri:level="1"><nlm:aff id="I1">Faculty of Life Sciences and Education, University of South Wales, Pontypridd CF37 1DL, UK</nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Faculty of Life Sciences and Education, University of South Wales, Pontypridd CF37 1DL</wicri:regionArea><wicri:noRegion>Pontypridd CF37 1DL</wicri:noRegion></affiliation></author><author><name sortKey="Kenkre, Joyce" sort="Kenkre, Joyce" uniqKey="Kenkre J" first="Joyce" last="Kenkre">Joyce Kenkre</name><affiliation wicri:level="1"><nlm:aff id="I1">Faculty of Life Sciences and Education, University of South Wales, Pontypridd CF37 1DL, UK</nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Faculty of Life Sciences and Education, University of South Wales, Pontypridd CF37 1DL</wicri:regionArea><wicri:noRegion>Pontypridd CF37 1DL</wicri:noRegion></affiliation></author><author><name sortKey="Williams, E Mark" sort="Williams, E Mark" uniqKey="Williams E" first="E Mark" last="Williams">E Mark Williams</name><affiliation wicri:level="1"><nlm:aff id="I1">Faculty of Life Sciences and Education, University of South Wales, Pontypridd CF37 1DL, UK</nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Faculty of Life Sciences and Education, University of South Wales, Pontypridd CF37 1DL</wicri:regionArea><wicri:noRegion>Pontypridd CF37 1DL</wicri:noRegion></affiliation></author></analytic><series><title level="j">BMC Family Practice</title><idno type="eISSN">1471-2296</idno><imprint><date when="2014">2014</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Background</title><p>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. 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.</p></sec><sec><title>Method</title><p>A self-reporting questionnaire was distributed to all 478 General Practices within Wales, sent via their responsible Health Boards.</p></sec><sec><title>Results</title><p>The 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).</p></sec><sec><title>Conclusion</title><p>ABI 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. 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uniqKey="Treat Jacobson D">D Treat-Jacobson</name></author><author><name sortKey="Reilly, Mp" uniqKey="Reilly M">MP Reilly</name></author><author><name sortKey="Cunningham, Ke" uniqKey="Cunningham K">KE Cunningham</name></author><author><name sortKey="Miani, M" uniqKey="Miani M">M Miani</name></author><author><name sortKey="Criqui, Mh" uniqKey="Criqui M">MH Criqui</name></author><author><name sortKey="Hiatt, Wr" uniqKey="Hiatt W">WR Hiatt</name></author><author><name sortKey="Hirsch, At" uniqKey="Hirsch A">AT Hirsch</name></author></analytic></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Moyer, Va" uniqKey="Moyer V">VA Moyer</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Grava Gubins, I" uniqKey="Grava Gubins I">I Grava-Gubins</name></author><author><name sortKey="Scott, S" uniqKey="Scott S">S Scott</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Britt, H" uniqKey="Britt H">H Britt</name></author><author><name sortKey="Miller, G" uniqKey="Miller G">G Miller</name></author><author><name sortKey="Bayram, C" uniqKey="Bayram C">C Bayram</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Nicolai, Sp" uniqKey="Nicolai S">SP Nicolaï</name></author><author><name sortKey="Kruidenier, Lm" uniqKey="Kruidenier L">LM Kruidenier</name></author><author><name sortKey="Rouwet, Ev" uniqKey="Rouwet E">EV Rouwet</name></author><author><name sortKey="Bartelink, Ml" uniqKey="Bartelink M">ML Bartelink</name></author><author><name sortKey="Prins, Mh" uniqKey="Prins M">MH Prins</name></author><author><name sortKey="Teijink, Ja" uniqKey="Teijink J">JA Teijink</name></author></analytic></biblStruct></listBibl></div1></back></TEI></record>Pour manipuler ce document sous Unix (Dilib)
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