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

BACKGROUND:Peripheral artery disease (PAD) is common and associated with future cardiovascular events. PAD is under-diagnosed, limiting opportunities to address secondary prevention of cardiovascular disease. It is unknown how closely guidelines for detection of PAD are followed in primary care. AIM:We aimed to survey general practitioners' (GPs) attitudes to diagnosis and follow-up of patients with PAD. DESIGN & SETTING:Online survey of general practitioners (GPs) in England and 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 inter-quartile ranges (IQR). RESULTS:111 responses were analysed; 68 (61%) from England and 43 (39%) from 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 ROI compared to GPs in England more often examined the heart (10/10 vs 7/10) or carotid vessels (5/10 vs 1/10). Lower limb pulses were palpated in response to symptoms or signs of PAD. In England, 25% of practitioners; in 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 whilst 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.