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Published in: BMC Primary Care 1/2014

Open Access 01-12-2014 | Research article

Current utility of the ankle-brachial index (ABI) in general practice: implications for its use in cardiovascular disease screening

Authors: Jane H Davies, Joyce Kenkre, E Mark Williams

Published in: BMC Primary Care | Issue 1/2014

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Abstract

Background

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.

Method

A self-reporting questionnaire was distributed to all 478 General Practices within Wales, sent via their responsible Health Boards.

Results

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).

Conclusion

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.
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Metadata
Title
Current utility of the ankle-brachial index (ABI) in general practice: implications for its use in cardiovascular disease screening
Authors
Jane H Davies
Joyce Kenkre
E Mark Williams
Publication date
01-12-2014
Publisher
BioMed Central
Published in
BMC Primary Care / Issue 1/2014
Electronic ISSN: 2731-4553
DOI
https://doi.org/10.1186/1471-2296-15-69

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