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. 2024 Jul 29;8(2):BJGPO.2023.0150.
doi: 10.3399/BJGPO.2023.0150. Print 2024 Jul.

Peripheral artery disease recognition, diagnosis, and management in general practice in the Republic of Ireland and England: an online survey

Judit Konya  1 , Sinead Tj McDonagh  2 , Peter Hayes  3 , Sebastian Debus  4 , Victor Aboyans  5 , Christopher E Clark  2 ; EuroPAD investigators
Affiliations

Peripheral artery disease recognition, diagnosis, and management in general practice in the Republic of Ireland and England: an online survey

Judit Konya et al. BJGP Open. .

Abstract

Background: Peripheral artery disease (PAD) is common and associated with future cardiovascular events. PAD is underdiagnosed, which limits opportunities to address secondary prevention of cardiovascular disease. It is unknown how closely guidelines for detection of PAD are followed in primary care.

Aim: To survey GPs' attitudes to diagnosis and follow-up of patients with PAD.

Design & setting: Online survey of GPs in England and the Republic of Ireland (RoI).

Method: GPs' approaches to management of PAD were assessed using likelihood ratings (scales of 0-10) and discrete questions. Findings were summarised as proportions, or median and interquartile ranges (IQR).

Results: In total, 111 responses were analysed; 68 (61%) from England and 43 (39%) from the RoI. Considering a hypothetical patient at risk of PAD, likelihood of GPs enquiring about PAD symptoms (leg pains: 3/10 or erectile dysfunction: 2/10) was low. GPs in the RoI compared with GPs in England more often examined the heart (10/10 versus 7/10) or carotid vessels (5/10 versus 1/10). Lower limb pulses were palpated in response to symptoms or signs of PAD. In England 25% of practitioners, and in the RoI 55% of practitioners, reported that they do not measure ankle-brachial index (ABI).

Conclusion: Currently, detection of PAD is generally triggered by 'classical' leg claudication symptoms, while known vascular risk factors appear to elicit little consideration. ABI measurement is not performed by many practitioners, suggesting that a proportion of vascular referrals must be based on history and examination findings alone. Opportunities to recognise PAD are missed.

Keywords: blood pressure; cardiovascular diseases; general practitioners; peripheral arterial disease; primary healthcare.

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Conflict of interest statement

CEC, VA, SD and the EuoPAD investigators were supported by honoraria from Bayer AG. CEC has received honoraria from ReCor medical for unrelated work.

Figures

Figure 1.
Figure 1.. Likelihood of (a) heart and (b) carotid auscultation by English and Irish GPs on reviewing a 65-year-old man for vascular risk
Figure 2.
Figure 2.. Likelihood of measuring ankle brachial index when leg pain symptoms are reported
See this image and copyright information in PMC

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