Ankle Brachial Index Measurement in Primary Care
Ankle Brachial Index Measurement in Primary Care
Background: Peripheral arterial disease (PAD) affects over 8 million people in the United States and has been found to be associated with an increased incidence of coronary and carotid artery disease. The ankle brachial index (ABI) measurement is a highly specific noninvasive screening and diagnostic test for PAD, but is rarely performed in primary care office settings. This study sought to determine the actual performance time involved in completing an ABI in a primary care office.
Methods: Data were collected by one provider on a convenience sample of women who met the inclusion criteria. The time was recorded at the beginning and upon the completion of the ABI procedure for each patient. Analysis of the time data was completed and barriers to performing the ABI were recorded by the provider.
Results: The average time to complete an ABI was 5 minutes, with a range of 3–11 minutes. In 83.8% of patient encounters, the ABI procedure took less than 6 minutes to complete. Barriers identified by the provider included the additional time needed to explain the test and assist patients into the proper testing position.
Conclusions: The actual performance time for an ABI in a primary care setting takes an average of 5 minutes, but additional time may be required for patient preparation and education. With proper scheduling and training, the ABI can be completed in a timely manner. The ABI is an important screening/diagnostic test that can be performed in primary care and potentially impact patient treatment plans.
Peripheral arterial disease (PAD) affects over 8 million people in the United States and the incidence is expected to increase due to the aging population. The effects of PAD can range from difficulty in completing daily activities to surgical amputation of a leg. Research also indicates that PAD is a consistent and significant predictor of coronary artery and carotid artery diseases, placing persons with PAD at a 6–7 fold increased risk of suffering from a cardiovascular event, such as a myocardial infarction or stroke. The ankle brachial index (ABI) has an important role in primary care, as it has been found to be an effective and cost efficient screening tool not only for PAD but also for coronary artery disease. Studies have shown that a low ABI (<0.90 mmHg) has a specificity of greater than 98% for the diagnosis of PAD and a greater than 92% specificity for the prediction of coronary artery disease and stroke.
However, PAD remains under-diagnosed in primary care settings for unknown reasons. In most cases, patients with PAD do not present with typical symptoms, which may contribute to less frequent diagnoses. In addition, ABI measurements are often not completed in primary care settings. The concern over the time involved in performing this diagnostic test may contribute to the underuse of this diagnostic tool; this study was designed to investigate the issue of ABI performance time.
While PAD is an issue for both men and women, this study focused on women as part of a larger research program aimed at studying early diagnosis and treatment for cardiovascular diseases in women. Over the past decade, research studies concerning cardiovascular diseases in women have led to a greater understanding of the pathophysiology, unique symptoms, event rates, and poorer outcomes among women with cardiovascular disease. The ABI could be part of the cardiovascular screening and diagnostic procedures performed on women in a primary care setting, which would, in turn, contribute to improved cardiac outcomes.
Abstract and Introduction
Abstract
Background: Peripheral arterial disease (PAD) affects over 8 million people in the United States and has been found to be associated with an increased incidence of coronary and carotid artery disease. The ankle brachial index (ABI) measurement is a highly specific noninvasive screening and diagnostic test for PAD, but is rarely performed in primary care office settings. This study sought to determine the actual performance time involved in completing an ABI in a primary care office.
Methods: Data were collected by one provider on a convenience sample of women who met the inclusion criteria. The time was recorded at the beginning and upon the completion of the ABI procedure for each patient. Analysis of the time data was completed and barriers to performing the ABI were recorded by the provider.
Results: The average time to complete an ABI was 5 minutes, with a range of 3–11 minutes. In 83.8% of patient encounters, the ABI procedure took less than 6 minutes to complete. Barriers identified by the provider included the additional time needed to explain the test and assist patients into the proper testing position.
Conclusions: The actual performance time for an ABI in a primary care setting takes an average of 5 minutes, but additional time may be required for patient preparation and education. With proper scheduling and training, the ABI can be completed in a timely manner. The ABI is an important screening/diagnostic test that can be performed in primary care and potentially impact patient treatment plans.
Introduction
Peripheral arterial disease (PAD) affects over 8 million people in the United States and the incidence is expected to increase due to the aging population. The effects of PAD can range from difficulty in completing daily activities to surgical amputation of a leg. Research also indicates that PAD is a consistent and significant predictor of coronary artery and carotid artery diseases, placing persons with PAD at a 6–7 fold increased risk of suffering from a cardiovascular event, such as a myocardial infarction or stroke. The ankle brachial index (ABI) has an important role in primary care, as it has been found to be an effective and cost efficient screening tool not only for PAD but also for coronary artery disease. Studies have shown that a low ABI (<0.90 mmHg) has a specificity of greater than 98% for the diagnosis of PAD and a greater than 92% specificity for the prediction of coronary artery disease and stroke.
However, PAD remains under-diagnosed in primary care settings for unknown reasons. In most cases, patients with PAD do not present with typical symptoms, which may contribute to less frequent diagnoses. In addition, ABI measurements are often not completed in primary care settings. The concern over the time involved in performing this diagnostic test may contribute to the underuse of this diagnostic tool; this study was designed to investigate the issue of ABI performance time.
While PAD is an issue for both men and women, this study focused on women as part of a larger research program aimed at studying early diagnosis and treatment for cardiovascular diseases in women. Over the past decade, research studies concerning cardiovascular diseases in women have led to a greater understanding of the pathophysiology, unique symptoms, event rates, and poorer outcomes among women with cardiovascular disease. The ABI could be part of the cardiovascular screening and diagnostic procedures performed on women in a primary care setting, which would, in turn, contribute to improved cardiac outcomes.
