Faculty of Life Sciences and Education, University of South Wales, Pontypridd CF37 1DL, UK.
BMC Fam Pract. 2014 Apr 17;15:69. doi: 10.1186/1471-2296-15-69.
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.
A self-reporting questionnaire was distributed to all 478 General Practices within Wales, sent via their responsible Health Boards.
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).
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.
外周动脉疾病（PAD）是全身动脉粥样硬化的标志，与心血管原因导致的死亡风险增加三到六倍有关。此外，它通常是无症状的且诊断不足；这导致人们强烈呼吁通过踝肱指数（ABI）测量来启动初级保健 PAD 筛查。然而，关于这种方法的可行性以及初级保健中是否已经存在进行此类任务所需的核心技能和知识，证据有限。本研究旨在确定 ABI 测量在威尔士所有 478 家全科诊所中的当前应用情况，并考虑将其作为心血管风险筛查工具的使用。
通过其负责的健康委员会向威尔士的所有 478 家全科诊所分发了一份自我报告问卷。
调查的回复率为 20%。ABI 测量主要由护士（93%）进行，用于伤口管理（90%）。它使用频率低（73% < 每月 4 次）且经常使用不当（42% 不符合当前 ABI 指南）。只有 52%的全科医生和 16%的护士报告说，ABI 为≤0.9 的患者需要积极进行心血管疾病危险因素的改变（如当前国家和国际指南所建议）。
在调查的全科诊所中，ABI 测量是一项未充分利用且经常使用不当的程序。在将其作为正式的心血管疾病筛查工具之前，需要制定一个具有标准化方法的强大培训计划，以优化结果的准确性和一致性。需要强调 PAD 诊断的意义，包括相关的心血管风险增加和必要的危险因素改变。
