title: Current utility of the ankle-brachial index (ABI) in general practice: implications for its use in cardiovascular disease screening.
abstract: BACKGROUND
  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.
  
  
  METHODS
  A self-reporting questionnaire was distributed to all 478 General Practices within Wales, sent via their responsible Health Boards.
  
  
  RESULTS
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Faculty of Life Sciences and Education, University of South Wales, Pontypridd CF37 1DL, UK. jane.davies@southwales.ac.uk.
authors.forename: Jane H
authors.initials: JH
authors.lastname: Davies
authors.forename: Joyce
authors.initials: J
authors.lastname: Kenkre
authors.forename: E Mark
authors.initials: EM
authors.lastname: Williams
mesh_terms: D055109:Ankle Brachial Index / Q000706:statistics & numerical data*; D002318:Cardiovascular Diseases / Q000175:diagnosis* / Q000628:therapy; D058005:General Practitioners / Q000523:psychology / Q000592:standards; D006075:Governing Board; D019983:Guideline Adherence; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008403:Mass Screening / Q000379:methods / Q000592:standards; D016491:Peripheral Vascular Diseases / Q000175:diagnosis*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012307:Risk Factors; D057566:Self Report; D011795:Surveys and Questionnaires; D014600:Utilization Review; D014852:Wales; D014947:Wounds and Injuries / Q000628:therapy
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