Screening for Peripheral Arterial Disease: Public Health Implications

BACKGROUND: One of twenty Americans over the age of 50 has peripheral arterial disease (PAD) characterized by clogging of the blood vessels supplying the legs. This population is at increased risk for heart attack, stroke, and amputation. Conflicting recommendations exist on the utility of targeted community-wide PAD screening of high risk individuals. Of issue is use of the Ankle-Brachial Index (ABI), a non-invasive test to diagnose PAD with a sensitivity of 79-95% and specificity of 95-100%. The public health issue is underscored by the existence of direct media advertising to consumers by commercial entities offering fee-for-service ABI screening. OBJECTIVE: The project goal was to research and create an educational pamphlet and PowerPoint presentation for patients and health care workers to increase awareness of the health consequences of PAD and available screening options. RESULTS: Barriers to the use of the ABI screening include (1) lack of awareness, motivation or expertise; (2)time restraints; (3)staff availability and training; (4)cost of equipment;(5) conflicting practice guidelines; (6) disagreement with recommendations (7) and reimbursement issues. These factors affect population-based screening decisions. CONCLUSION: The public health burden of PAD is large. Increasing public awareness will contribute to improved disease management and decrease public health consequences. PAD provides a means to examine relevant issues related to community-based screening for disease.