title: Applicability of the ankle-brachial-index measurement as screening device for high cardiovascular risk: an observational study.
abstract: BACKGROUND
  Screening with ankle-brachial index (ABI) measurement could be clinically relevant to avoid cardiovascular events in subjects with asymptomatic atherosclerosis. To assess the practical impact of guidelines regarding the use of ABI as a screening tool in general practice, the corresponding number needed to screen, including the required time investment, and the feasibility of ABI performance, was assessed.
  
  
  METHODS
  An observational study was performed in the setting of 955 general practices in the Netherlands. Overall, 13,038 subjects of ≥55 years presenting with symptoms of intermittent claudication and/or presenting with ≥ one vascular risk factor were included. Several guidelines recommend the ABI as an additional measurement in selected populations for risk assessment for cardiovascular morbidity.
  
  
  RESULTS
  Screening of the overall population of ≥50 years results in ≈ 862 subjects per general practice who should be screened, resulting in a time-requirement of approximately 6 weeks of full time work. Using an existing clinical prediction model, 247 patients per general practice should be screened for PAD by ABI measurement.
  
  
  CONCLUSIONS
  Screening the entire population of ≥50 years will in our opinion not be feasible in general practice. A more rationale and efficient approach might be screening of subsets of the population of ≥55 years based on a clinical prediction model.
authors: Department of Vascular Surgery, Catharina Hospital, Eindhoven, The Netherlands. b.bendermacher@live.nl
authors: Bianca L W
authors: BL
authors: Bendermacher
authors: Joep A W
authors: JA
authors: Teijink
authors: Edith M
authors: EM
authors: Willigendael
authors: Marie-Louise
authors: ML
authors: Bartelink
authors: Ron J G
authors: RJ
authors: Peters
authors: Machteld
authors: M
authors: Langenberg
authors: Harry R
authors: HR
authors: Büller
authors: Martin H
authors: MH
authors: Prins
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D055109:Ankle Brachial Index / Q000592:standards; D058070:Asymptomatic Diseases; D002318:Cardiovascular Diseases / Q000175:diagnosis* / Q000453:epidemiology / Q000503:physiopathology; D015897:Comorbidity; D005240:Feasibility Studies; D005260:Female; D058006:General Practice; D019983:Guideline Adherence; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods* / Q000592:standards; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D018579:Patient Selection; D058729:Peripheral Arterial Disease / Q000175:diagnosis* / Q000453:epidemiology / Q000503:physiopathology; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D011237:Predictive Value of Tests; D015995:Prevalence; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors