TY - JOUR
T1 - Peripheral artery disease recognition, diagnosis, and management in general practice in the Republic of Ireland and England
T2 - an online survey
AU - EuroPAD investigators
AU - Konya, Judit
AU - McDonagh, Sinead T.J.
AU - Hayes, Peter
AU - Debus, Sebastian
AU - Aboyans, Victor
AU - Clark, Christopher E.
N1 - Publisher Copyright:
Copyright © 2024, The Authors; This article is Open Access: CC BY license (https://creativecommons.org/licenses/by/4.0/)
PY - 2024
Y1 - 2024
N2 - Background: Peripheral artery disease (PAD) is common and associated with future cardiovascular events. PAD is underdiagnosed, which limits opportunities to address secondary prevention of cardiovascular disease. It is unknown how closely guidelines for detection of PAD are followed in primary care. Aim: To survey GPs’ attitudes to diagnosis and follow-up of patients with PAD. Design & setting: Online survey of GPs in England and the Republic of Ireland (RoI). Method: GPs’ approaches to management of PAD were assessed using likelihood ratings (scales of 0–10) and discrete questions. Findings were summarised as proportions, or median and interquartile ranges (IQR). Results: In total, 111 responses were analysed; 68 (61%) from England and 43 (39%) from the RoI. Considering a hypothetical patient at risk of PAD, likelihood of GPs enquiring about PAD symptoms (leg pains: 3/10 or erectile dysfunction: 2/10) was low. GPs in the RoI compared with GPs in England more often examined the heart (10/10 versus 7/10) or carotid vessels (5/10 versus 1/10). Lower limb pulses were palpated in response to symptoms or signs of PAD. In England 25% of practitioners, and in the RoI 55% of practitioners, reported that they do not measure ankle-brachial index (ABI). Conclusion: Currently, detection of PAD is generally triggered by ‘classical’ leg claudication symptoms, while known vascular risk factors appear to elicit little consideration. ABI measurement is not performed by many practitioners, suggesting that a proportion of vascular referrals must be based on history and examination findings alone. Opportunities to recognise PAD are missed.
AB - Background: Peripheral artery disease (PAD) is common and associated with future cardiovascular events. PAD is underdiagnosed, which limits opportunities to address secondary prevention of cardiovascular disease. It is unknown how closely guidelines for detection of PAD are followed in primary care. Aim: To survey GPs’ attitudes to diagnosis and follow-up of patients with PAD. Design & setting: Online survey of GPs in England and the Republic of Ireland (RoI). Method: GPs’ approaches to management of PAD were assessed using likelihood ratings (scales of 0–10) and discrete questions. Findings were summarised as proportions, or median and interquartile ranges (IQR). Results: In total, 111 responses were analysed; 68 (61%) from England and 43 (39%) from the RoI. Considering a hypothetical patient at risk of PAD, likelihood of GPs enquiring about PAD symptoms (leg pains: 3/10 or erectile dysfunction: 2/10) was low. GPs in the RoI compared with GPs in England more often examined the heart (10/10 versus 7/10) or carotid vessels (5/10 versus 1/10). Lower limb pulses were palpated in response to symptoms or signs of PAD. In England 25% of practitioners, and in the RoI 55% of practitioners, reported that they do not measure ankle-brachial index (ABI). Conclusion: Currently, detection of PAD is generally triggered by ‘classical’ leg claudication symptoms, while known vascular risk factors appear to elicit little consideration. ABI measurement is not performed by many practitioners, suggesting that a proportion of vascular referrals must be based on history and examination findings alone. Opportunities to recognise PAD are missed.
KW - blood pressure
KW - cardiovascular diseases
KW - general practitioners
KW - peripheral arterial disease
KW - primary healthcare
UR - http://www.scopus.com/inward/record.url?scp=85200590930&partnerID=8YFLogxK
U2 - 10.3399/BJGPO.2023.0150
DO - 10.3399/BJGPO.2023.0150
M3 - Article
AN - SCOPUS:85200590930
SN - 2398-3795
VL - 8
SP - 1
EP - 9
JO - BJGP Open
JF - BJGP Open
IS - 2
M1 - BJGPO.2023.0150
ER -