چکیده (انگلیسی):

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.