Feasibility of screening for silent myocardial ischaemia according to the ALFEDIAM-SFC 2004 Guidelines in a population of diabetic patients.
BACKGROUND
Screening tests have to meet a number of criteria, including feasibility. The aim of this study was to estimate the proportion of the French diabetic population that is eligible for screening for silent myocardial ischaemia (SMI), and to evaluate the feasibility of such screening in the Franche-Comté region.


METHODS
Data were taken from the Echantillon National Témoin Représentatif de la Population Diabétique (ENTRED, a Representative National Sample of the Diabetic Population 2001 study), which was based on questionnaires filled out by 3646 diabetic patients. All screening tests carried out in the region of Franche-Comté in eastern France in 2003 were recorded (n=19,216).


RESULTS
The guidelines issued by the ALFEDIAM-SFC in 2004 were applied to the ENTRED population and identified 645 diabetic patients (17%) as eligible for SMI screening. When applied to the region of Franche-Comté, the recommendations would have required screening 7480 diabetic patients over a period of 3years, involving 1246 exercise stress tests and 1246 myocardial perfusion or stress echocardiography studies annually. However, more than 14,653 exercise stress, 4248 myocardial perfusion and 315 stress echocardiography tests were carried out in the region in 2003 among diabetic and non-diabetic patients, thus largely covering the screening requirements. On the other hand, ENTRED 2001 data also showed that 60% of patients who reported existing coronary disease would not have met screening criteria.


CONCLUSIONS
The number of examinations carried out in the region of Franche-Comté greatly exceeded the number of patients required for screening. However, practical feasibility is not the only criterion needed to guarantee the quality of a large-scale screening programme. Our results raise the question of the relevance of the current screening selection criteria.
Hiebel
A
A
Service d'endocrinologie-métabolisme et diabétologie-nutrition, hôpital Jean-Minjoz, EA3920, université de Franche-Comté, 3, boulevard Fleming, 25030 Besançon cedex, France.
Fagot-Campagna
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A
Fosse
S
S
Varroud-Vial
M
M
Weill
A
A
Penfornis
A
A
D000328:Adult; D000368:Aged; D003922:Diabetes Mellitus, Type 1 / Q000150:complications; D003924:Diabetes Mellitus, Type 2 / Q000150:complications; D003925:Diabetic Angiopathies / Q000175:diagnosis / Q000191:economics / Q000453:epidemiology / Q000517:prevention & control; D004180:Direct Service Costs; D005240:Feasibility Studies; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000191:economics; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000175:diagnosis / Q000191:economics / Q000453:epidemiology / Q000517:prevention & control; D017410:Practice Guidelines as Topic; D018570:Risk Assessment; D012307:Risk Factors; D011795:Surveys and Questionnaires