Institute of Health and Society, Université Catholique de Louvain, Clos Chapelle-aux-Champs 30, bte 3005, 1200 Brussels, Belgium.
BMC Fam Pract. 2011 May 23;12:39. doi: 10.1186/1471-2296-12-39.
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.
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.
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.
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.
外周动脉疾病（PAD）在老年人中很常见。踝臂指数（ABI）<0.9 可作为 PAD 的指标。ABI 低的患者死亡率增加，严重心血管发病率风险更高。然而，由于 80%的患者无症状，因此很大一部分患者的 PAD 仍未被识别。本研究的目的是：1）检查 80 岁及以上人群中 ABI 降低的患病率；2）确定病史和临床检查对 ABI 降低的诊断准确性；3）调查 ABI 降低患者与无 ABI 降低患者之间的功能和体力活动差异。
一项横断面研究，嵌入在 BELFRAIL 研究中。比利时豪埃拉尔特的全科医生（GP）中心招募了 239 名 80 岁或以上的患者。仅使用了三个排除标准：紧急医疗需求、姑息治疗情况和已知严重痴呆。GP 记录了病史并进行了临床检查。临床研究助理进行了广泛的检查，包括简易精神状态检查（MMSE）、老年抑郁量表（GDS-15）、日常生活活动（ADL）、Tinetti 测试和 LASA 体力活动问卷（LAPAQ）。使用自动振荡式设备测量 ABI。
40%的患者存在 ABI 降低。心血管危险因素无法识别 ABI 降低的患者。ABI 与心血管疾病数量呈负相关。心血管疾病的敏感性为 65.7%（95%CI 53.4-76.7），特异性为 48.6%（95%CI 38.7-58.5）。周围动脉触诊的阴性预测值最高（77.7%（95%CI 71.8-82.9%））。ABI 降低组的 LAPAQ 评分明显较低。
在一般实践中，80 岁及以上患者的 PAD 患病率非常高。临床检查、心血管危险因素和心血管疾病的存在均无法识别 ABI 降低的患者。如果未来研究为 80 岁及以上 ABI 降低的患者提供有效的干预措施，则可以考虑通过确定 ABI 来制定 PAD 筛查策略。
