A Cost Effectiveness Analysis of Using the Ankle-Brachial Index to Screen for Peripheral Artery Disease.

摘要

Peripheral artery disease (PAD), a common circulatory problem in which narrowed arteries reduce blood flow to limbs, is a major public health problem. A robust epidemiologic literature shows that patients with PAD have up to three times the risk of all cause mortality. The risks of death from coronary artery disease are up to six times greater for PAD patients in comparison to those without the disease. PAD, however, is usually not recognized as a major public health threat and motivation to evaluate patients for PAD is much lower than it is for other cardiovascular conditions. Peripheral artery disease is a serious health condition that increases an individual's risk for heart attack, stroke, and leg amputation. While PAD is highly prevalent in primary care settings and is easily detected with the ABI during a routine office visit, the procedure is underutilized and without a pulse volume recording or Doppler waveform tracings, it is not reimbursable by healthcare payers. Demonstration that the ABI is a low cost and effective screening technique for identifying PAD in patients with cardiovascular risk factors would support its adoption into primary care and specialty care settings. Furthermore, newly identified PAD patients could be targeted for prevention measures such as treatment with antiplatelet drugs, ACE inhibitors, and statins, decreasing their overall risk of cardiovascular events while increasing functionality and quality of life. With the combined high risk that PAD represents and the availability of effective treatment, systematic use of screening using the ABI to identify patients with asymptomatic PAD is warranted in patients with cardiovascular risk, and is critical to reduce overall morbidity and mortality.