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BMC Primary Care
Published in: BMC Primary Care 1/2011

Open Access 01-12-2011 | Research article

To screen or not to screen for peripheral arterial disease in subjects aged 80 and over in primary health care: a cross-sectional analysis from the BELFRAIL study

Authors: Stein Bergiers, Bert Vaes, Jan Degryse

Published in: BMC Primary Care | Issue 1/2011

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Abstract

Background

Peripheral arterial disease (PAD) is common in older people. An ankle-brachial index (ABI) < 0.9 can be used as an indicator of PAD. Patients with low ABI have increased mortality and a higher risk of serious cardiovascular morbidity. However, because 80% of the patients are asymptomatic, PAD remains unrecognised in a large group of patients. The aims of this study were 1) to examine the prevalence of reduced ABI in subjects aged 80 and over, 2) to determine the diagnostic accuracy of the medical history and clinical examination for reduced ABI and 3) to investigate the difference in functioning and physical activity between patients with and without reduced ABI.

Methods

A cross-sectional study embedded within the BELFRAIL study. A general practitioner (GP) centre, located in Hoeilaart, Belgium, recruited 239 patients aged 80 or older. Only three criteria for exclusion were used: urgent medical need, palliative situation and known serious dementia. The GP recorded the medical history and performed a clinical examination. The clinical research assistant performed an extensive examination including Mini-Mental State Examination (MMSE), Geriatric Depression Scale (GDS-15), Activities of Daily Living (ADL), Tinetti test and the LASA Physical Activity Questionnaire (LAPAQ). ABI was measured using an automatic oscillometric appliance.

Results

In 40% of patients, a reduced ABI was found. Cardiovascular risk factors were unable to identify patients with low ABI. A negative correlation was found between the number of cardiovascular morbidities and ABI. Cardiovascular morbidity had a sensitivity of 65.7% (95% CI 53.4-76.7) and a specificity of 48.6% (95% CI 38.7-58.5). Palpation of the peripheral arteries showed the highest negative predictive value (77.7% (95% CI 71.8-82.9)). The LAPAQ score was significantly lower in the group with reduced ABI.

Conclusion

The prevalence of PAD is very high in patients aged 80 and over in general practice. The clinical examination, cardiovascular risk factors and the presence of cardiovascular morbidity were not able to identify patients with a low ABI. A screening strategy for PAD by determining ABI could be considered if effective interventions for those aged 80 and over with a low ABI become available through future research.
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Literature
1.
Meijer WT, Grobbee DE, Hunink MG, Hofman A, Hoes AW: Determinants of peripheral arterial disease in the elderly: the Rotterdam study. Arch Intern Med. 2000, 160: 2934-2938.CrossRefPubMed
2.
Bartelink ML, Stoffers HEJH, Boutens EJ, Hooi JD, Kaiser V, Boomsma LJ: NHG-standaard Perifeer arterieel vaatlijden. Huisarts Wet. 2003, 46: 848-858.CrossRef
3.
Fowkes FGR, Housley E, Cawood EHH, Macintyre CCA, Ruckley CV, Prescott RJ: Edinburgh Artery Study: prevalence of asymptomatic and symptomatic peripheral arterial disease in the general population. Int J Epidemiol. 1991, 20: 384-392.CrossRefPubMed
4.
Schroll M, Munck O: Estimation of peripheral arteriosclerotic disease by ankle blood pressure measurements in a population of 60-year-old men and women. J Chronic Dis. 1981, 34: 261-269.CrossRefPubMed
5.
Stoffers HE, Kester AD, Kaiser V, Rinkens PE, Kitslaar PJ, Knottnerus JA: The diagnostic value of the measurement of the ankle-brachial systolic pressure index in primary health care. J Clin Epidemiol. 1996, 49: 1401-1405.CrossRefPubMed
6.
Guo X, Li J, Pang W, Zhao M, Luo Y, Sun Y, Hu D: Sensitivity and specificity of ankle-brachial index for detecting angiographic stenosis of peripheral arteries. Circ J. 2008, 72: 605-610.CrossRefPubMed
7.
Stoffers HE, Rinkens PE, Kester AD, Kaiser V, Knottnerus JA: The Prevalence of Asymptomatic and Unrecognized Peripheral Arterial Occlusive Disease. Int J Epidemiol. 1996, 25: 282-290.CrossRefPubMed
8.
9.
Newman AB, Siscovick DS, Manolio TA, Polak J, Fried LP, Borhani NO, Wolfson SK: Ankle-arm index as a marker of atherosclerosis in the Cardiovascular Health Study. Cardiovascular Heart Study (CHS) Collaborative Research Group. Circulation. 1993, 88: 837-845.CrossRefPubMed
10.
Diehm C, Lange S, Darius H, Pittrow D, von Stritzky B, Tepohl G, Haberl RL, Allenberg JR, Dasch B, Trampisch HJ: Association of low ankle brachial index with high mortality in primary care. Eur Heart J. 2006, 27: 1743-1749.CrossRefPubMed
11.
Meves SH, Diehm C, Berger K, Pittrow D, Trampisch HJ, Burghaus I, Tepohl G, Allenberg JR, Endres HG, Schwertfeger M, Darius H, Haberl RL: Peripheral Arterial Disease as an Independent Predictor for Excess Stroke Morbidity and Mortality in Primary-Care Patients: 5-Year Results of the getABI Study. Cerebrovasc Dis. 2010, 29: 546-554.CrossRefPubMed
12.
Ankle brachial Index Collaboration: Ankle brachial index combined with Framingham Risk Score to predict cardiovascular events and mortality: a meta-analysis. JAMA. 2008, 300: 197-208.CrossRefPubMedCentral
13.
Resnick HE, Lindsay RS, McDermott MM, Devereux RB, Jones KL, Fabsitz RR, Howard BV: Relationship of high and low ankle brachial index to all-cause and cardiovascular disease mortality: the Strong Heart Study. Circulation. 2004, 109: 733-739.CrossRefPubMed
14.
Leng GC, Fowkes FG, Dunbar J, Housley E, Ruckley CV: Use of ankle brachial pressure index to predict cardiovascular events and death; a cohort study. BMJ. 1996, 313: 1440-1444.CrossRefPubMedPubMedCentral
15.
Ferreira AC, Macedo FY: A review of simple, non-invasive means of assessing peripheral arterial disease and implications for medical management. Ann Med. 2010, 42: 139-150.CrossRefPubMed
16.
Nicolaï SP, Kruidenier LM, Rouwet EV, Bartelink ML, Prins MH, Teijink JA: EAI measurement in PC are we doing it right?. Br J Gen Pract. 2009, 59: 422-427.CrossRefPubMedPubMedCentral
17.
Beckman JA, Higgins CO, Gerhard-Herman M: Automated oscillometric determination of the ankle-brachial index provides accuracy necessary for office practice. Hypertension. 2006, 47: 35-38.CrossRefPubMed
18.
Benchimol A, Bernard V, Pillois X, Hong NT, Benchimol D, Bonnet J: Validation of a new method of detecting peripheral artery disease by determination of ankle-brachial index using an automatic blood pressure device. Angiology. 2004, 55: 127-134.CrossRefPubMed
19.
Diehm N, Dick F, Czuprin C, Lawall H, Baumgartner I, Diehm C: Oscillometric measurement of ankle-brachial index in patients with suspected peripheral disease: comparison with Doppler method. Swiss Med Wkly. 2009, 139: 357-363.PubMed
20.
Mehlsen J, Wiinberg N, Bruce C: Oscillometric blood pressure measurement: a simple method in screening for peripheral arterial disease. Clin Physiol Funct Imaging. 2008, 28: 426-429.CrossRefPubMed
21.
Mcdermott MM: The magnitude of the problem of peripheral arterial disease: Epidemiology and clinical significance. Cleve Clin J Med. 2006, 73 (Suppl 4): S2-7.CrossRefPubMed
22.
Hirsch TA, Criqui MH, Jacobson DT: Peripheral Arterial Disease Detection, Awareness, and Treatment in Primary Care. JAMA. 2001, 286: 1317-1324.CrossRefPubMed
23.
Van Bemmel T, Gussekloo J, Westendorp RG, Blauw GJ: In a population-based prospective study, no association between high blood pressure and mortality after age 85 years. J Hypertens. 2006, 24: 287-292.CrossRefPubMed
24.
Vaes B, Pasquet A, Wallemacq P, Rezzoug N, Mekkouar H, Olivier PA, Legrand D, Matheï C, Van Pottelbergh G, Degryse J: The BELFRAIL (BFC80+) study: a Population-based Prospective Cohort Study of Very Elderly in Belgium. BMC Geriatrics. 2010, 10: 39-CrossRefPubMedPubMedCentral
25.
Tombaugh JA, McIntyre NJ: The mini-mental state examination: a comprehensive review. J Am Geriatr Soc. 1992, 40: 922-935.CrossRefPubMed
26.
Pomeroy IM, Clark CR, Philp I: The effectiveness of very short scales for depression screening in elderly medical patients. Int J Geriatr Psychiatry. 2001, 16: 321-326.CrossRefPubMed
27.
Herrmann N, Mittmann N, Silver IL, Shulman KI, Busto UA, Shear NH, Naranjo CA: A validation study of the geriatric depression scale short form. Int J Geriatr Psychiatry. 1996, 11: 457-460.CrossRef
28.
de Craen AJ, Heeren TJ, Gussekloo J: Accuracy of the 15-item geriatric depression scale (GDS-15) in a community sample of the oldest old. Int J Geriatr Psychiatry. 2003, 18: 63-66.CrossRefPubMed
29.
van Sonsbeek JLA: Methodological and substantial aspects of the OECD indicator of chronic functional limitations. Maandbericht Gezondheid (CBS). 1988, 88: 4-17.
30.
Tinetti ME: Performance-oriented assessment of mobility in elderly patients. J Am Geriatr Soc. 1993, 34: 119-126.CrossRef
31.
Stel VS, Smit JH, Pluijm SM, Visser M, Deeg DJ, Lips P: Comparison of the LASA Physical Activity Questionnaire with a 7-day diary and pedometer. J Clin Epidemiol. 2004, 57: 252-258.CrossRefPubMed
32.
Guralnik JM, Simonsick EM, Ferrucci L, Glynn RJ, Berkman LF, Blazer DG, Scherr PA, Wallace RB: A short physical performance battery assessing lower extremity function: association with self-reported disability and prediction of mortality and nursing home admission. J Gerontol. 1994, 49: M85-94.CrossRefPubMed
33.
34.
Suominen V, Rantanen T, Heikkinen E, Venermo M, Salenius J: Peripheral arterial disease and its clinical significance in nonagenarians. Aging Clin Exp Res. 2008, 20: 211-215.CrossRefPubMed
35.
Coni W, Tennison B, Troup MI: Prevalence of lower extremity arterial disease among elderly people in the community. Brit J Gen Pract. 1992, 42: 149-152.
36.
de Ruijter W, Westendorp RG, Assendelft WJ, den Elzen WP, de Craen AJ, le Cessie S, Gussekloo J: Use of Framingham risk score and new biomarkers to predict cardiovascular mortality in older people: population based observational cohort study. BMJ. 2009, 338: a3083-CrossRefPubMedPubMedCentral
37.
Cacoub BP, Cambou JP, Kownator S, Belliard JP, Beregi JP, Branchereau A, Carpentier P, Léger P, Luizy F, Maïza D, Mihci E, Herrmann MA, Priollet P: Prevalence of peripheral arterial disease in high-risk patients using ankle-brachial index in general practice a cross-sectional study. Int J Clin Pract. 2009, 63: 63-70.CrossRefPubMedPubMedCentral
38.
Collins TC, Suares-Almazor M, Petersen NJ: An absent pulse is not sensitive for the early detection of peripheral arterial disease. Fam Med. 2006, 38: 38-42.PubMed
39.
Khan NA, Rahim AS, Anand SS: Does the clinical examination predict lower extremity peripheral arterial disease?. JAMA. 2006, 295: 536-46.CrossRefPubMed
40.
41.
Goodney P, Beck A, Nagle J, Welch G, Zwolak R: National trends in lower extremity bypass surgery, endovascular interventions and major amputations. J Vasc Surg. 2009, 50: 54-60.CrossRefPubMed
42.
U.S. Preventive Services Task Force: Screening for peripheral arterial disease: recommendation statement. Am Fam Physician. 2006, 73: 497-500.
43.
Guralnik JM, Ferrucci L, Simonsick EM, Salive ME, Wallace RB: Lower-extremity function in persons over the age of 70 years as a predictor of subsequent disability. N Engl J Med. 1995, 332: 556-561.CrossRefPubMed
44.
McDermott MM, Greenland P, Liu K, Guralnik JM, Celic L, Criqui MH, Chan C, Martin GJ, Schneider J, Pearce WH, Taylor LM, Clark E: The Ankle Brachial Index Is associated with Leg function and physical activity: The Walking and Leg Circulation Study. Ann Intern Med. 2002, 136: 873-883.CrossRefPubMed
Metadata
Title
To screen or not to screen for peripheral arterial disease in subjects aged 80 and over in primary health care: a cross-sectional analysis from the BELFRAIL study
Authors
Stein Bergiers
Bert Vaes
Jan Degryse
Publication date
01-12-2011
Publisher
BioMed Central
Published in
BMC Primary Care / Issue 1/2011
Electronic ISSN: 2731-4553
DOI
https://doi.org/10.1186/1471-2296-12-39

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