title: Primary care screening for peripheral arterial disease: a cross-sectional observational study.
abstract: BACKGROUND
  Early identification of peripheral arterial disease (PAD) and subsequent instigation of risk modification strategies could minimise disease progression and reduce overall risk of cardiovascular (CV) mortality. However, the feasibility and value of primary care PAD screening is uncertain.
  
  
  OBJECTIVE
  This study (the PIPETTE study - Peripheral arterial disease In Primary carE: Targeted screening and subsequenT managEment) aimed to determine the value of a proposed primary care PAD screening strategy. Outcomes assessed were: prevalence of PAD and agreement of ankle- brachial index (ABI)-defined PAD (ABI ≤0.9) with QRISK®2-defined high CV risk (≥20).
  
  
  METHODS
  A cross-sectional observational study was undertaken in a large general practice in Merthyr Tydfil, Wales.
  
  
  METHODS
  In total, 1101 individuals with ≥2 pre-identified CV risk factors but no known CV disease or diabetes were invited to participate. Participants underwent ABI measurement and QRISK2 assessment, and completed Edinburgh Claudication Questionnaires.
  
  
  RESULTS
  A total of 368 people participated in the study (participation rate: 33%). Prevalence of PAD was 3% (n = 12). The number needed to screen (NNS) to detect one new case of PAD was 31. Refining the study population to those aged ≥50 years with a smoking history reduced the NNS to 14, while still identifying 100% of PAD cases. Of participants with PAD, 33% reported severe lifestyle-limiting symptoms of intermittent claudication that warranted subsequent endovascular intervention, yet had not previously presented to their GP. The QRISK2 score predicted high CV risk in 92% of participants with PAD.
  
  
  CONCLUSIONS
  The low PAD yield and the fact that QRISK2 was largely comparable to the ABI in predicting high CV risk suggests that routine PAD screening may be unwarranted. Instead, strategies to improve public awareness of PAD are needed.
authors.affiliation: South East Wales Trials Unit (SEWTU), Centre for Trials Research, Cardiff University, Cardiff.
authors.forename: Jane H
authors.initials: JH
authors.lastname: Davies
authors.affiliation: Cwm Taf University Health Board, Merthyr Tydfil.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Richards
authors.affiliation: Cwm Taf University Health Board, Merthyr Tydfil.
authors.forename: Kevin
authors.initials: K
authors.lastname: Conway
authors.affiliation: Faculty of Life Sciences and Education, University of South Wales, Pontypridd.
authors.forename: Joyce E
authors.initials: JE
authors.lastname: Kenkre
authors.affiliation: School of Health Sciences, Cardiff Metropolitan University, Cardiff.
authors.forename: Jane Ea
authors.initials: JE
authors.lastname: Lewis
authors.affiliation: Faculty of Life Sciences and Education, University of South Wales, Pontypridd.
authors.forename: E
authors.initials: E
authors.lastname: Mark Williams
mesh_terms: D000368:Aged; D003430:Cross-Sectional Studies; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods; D008875:Middle Aged; D058729:Peripheral Arterial Disease / Q000175:diagnosis* / Q000453:epidemiology / Q000517:prevention & control; D010808:Physical Examination / Q000379:methods*; D015995:Prevalence; D011320:Primary Health Care / Q000458:organization & administration; D018570:Risk Assessment; D012307:Risk Factors; D014852:Wales
keywords: cardiovascular risk assessment; general practice; peripheral arterial disease; primary health care; screening