Primary care screening for peripheral arterial disease: a cross-sectional observational study
Davies, Jane H.
Lewis, Jane E. A.
Williams, E. Mark
Royal College of General Practitioners
MetadataShow full item record
Background: Early 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. Aim: This 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 setting: A cross-sectional observational study was undertaken in a large general practice in Merthyr Tydfil, Wales. Method: In 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. Results: A 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. Conclusion: The 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.
British Journal of General Practice;
Davies, J.H., Richards, J., Conway, K., Kenkre, J.E., Lewis, J.E. and Williams, E.M. (2017) 'Primary care screening for peripheral arterial disease: a cross-sectional observational study', British Journal of General Practice, 67(655), pp.e103-e110. DOI: 10.3399/bjgp17X689137.
Article published in British Journal of General Practice in February 2017, available open access at: https://doi.org/10.3399/bjgp17X689137.
Cardiff Metropolitan University (Grant ID: Cardiff Metropolian (Internal))
Showing items related by title, author, subject and abstract.
Combining diabetic foot and retinopathy screening: A step in the right direction? – a feasibility study Lewis, Jane E. A.; Morris, Keith; Powell, Thomas; Thomas, Rebecca; Owens, David (Sage, 2020-07-28)Objectives: Peripheral artery disease is a major cardiovascular disease affecting more than 200 million people globally and up to 4 times more frequent in the diabetic population. It can lead to lower extremity amputations ...
The primary prevention of cardiovascular disease in women with an emphasis on physical activity: A social marketing approach Sawyer, Ceinwen (Cardiff Metropolitan University, 2012)The policies of the Welsh Assembly Government (WAG) regarding the health of the Welsh population are underpinned by a social marketing approach. This is where the individual is supported in their efforts to take personal ...
Nwankwo, Florence; Shin, Hyunjae Daniel; Al-Habaibeh, Amin; Massoud, Hiba (SAGE, 2019-09-22)Limited screen time has been recommended by the American Academy of Pediatrics for all children and no screen time for children under 2 years of age. With the advancement in technology, the prevalence and detrimental effects ...