[Routine ankle brachial pressure index measurement for peripheral artery disease diagnosis in internal medicine department: Comparison with the recommendations of the Haute Autorité de Santé. Prospective descriptive study about 106 patients].
OBJECTIVE
The ankle brachial pressure index (ABPI) makes it possible to diagnose peripheral artery disease (PAD) and identify patients with a vascular risk. Recently, the Haute Autorité de santé (HAS) issued guidelines. We wanted to determine the interest and impact of these guidelines when applied to patients hospitalised in an internal medicine department.


METHODS
We systematically measured the ABPI in two internal medicine departments. We compared the results obtained with the screening criteria and the good practices recommended by the HAS.


RESULTS
The screening criteria recommended by the HAS were already applied in 91% of our 97 patients. PAD was found in 37.1% of patients. In 83% of cases, the diagnosis was unknown (p = 0.02). The PAD was symptomatic in 83% of the known PAD cases, and 3.3% in newly-diagnosed cases (p < 0.001)). The sensitivity of the HAS screening criteria applied to our population was 100% but almost patients justifies ABPI screening. The specificity was 11.5%, the positive predictive value 40% and the negative predictive value 100%. The optimal treatment recommended was implemented in only 50% of patients with known arteriopathy and in 10% of newly-diagnose PAD (p = 0.04).


CONCLUSIONS
PAD prevalence is high in internal medicine department and systematic measurement of ABPI is effective. Determining patients to screen with the HAS criteria has a poor impact in our patients. The optimal treatment is still extremely under-prescribed even in patients with known PAD.
CHU de Dijon, hôpital général, médecine interne et maladies systémiques, 21033 Dijon cedex, France. julien.vinit@chu-dijon.fr
Julien
J
Vinit
Philip
P
Bielefeld
Géraldine
G
Muller
Bernard
B
Bonnotte
Bernard
B
Lorcerie
Jean-François
JF
Besancenot
Béatrice
B
Terriat
D000293:Adolescent; D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D055109:Ankle Brachial Index; D001157:Arterial Occlusive Diseases / Q000175:diagnosis* / Q000188:drug therapy / Q000503:physiopathology; D001786:Blood Glucose / Q000378:metabolism; D002121:Calcium Channel Blockers / Q000627:therapeutic use; D015897:Comorbidity; D003925:Diabetic Angiopathies / Q000175:diagnosis / Q000188:drug therapy / Q000503:physiopathology; D005260:Female; D005602:France; D019983:Guideline Adherence; D006748:Hospital Departments; D006801:Humans; D006949:Hyperlipidemias / Q000175:diagnosis / Q000188:drug therapy / Q000503:physiopathology; D007383:Intermittent Claudication / Q000175:diagnosis / Q000188:drug therapy / Q000503:physiopathology; D007388:Internal Medicine; D007511:Ischemia / Q000175:diagnosis* / Q000188:drug therapy / Q000503:physiopathology; D007866:Leg / Q000098:blood supply; D008055:Lipids / Q000097:blood; D008297:Male; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D011446:Prospective Studies; D012016:Reference Values; D012307:Risk Factors; D014665:Vasodilator Agents / Q000627:therapeutic use; D055815:Young Adult
D000319:Adrenergic beta-Antagonists; D001786:Blood Glucose; D002121:Calcium Channel Blockers; D008055:Lipids; D010975:Platelet Aggregation Inhibitors; D014665:Vasodilator Agents