Implementation of Ankle-Brachial Index to Screen for Peripheral Artery Disease in High-Risk Asymptomatic Populations
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Abstract
Peripheral Artery Disease (PAD) prevalence continues to rise with millions of individuals affected worldwide. PAD affects vasculature of the peripheries and the aorta, but it is also a critical risk factor for cardiovascular and cerebrovascular disease (Fowkes et al., 2008). Diagnosis is easily made utilizing the Ankle-Brachial Index (ABI) with indication of disease at a level of 0.9 or less or 1.4 or higher (American Heart Association, 2016). Risk factors for PAD include smoking, diabetes, hypertension, hyperlipidemia, family history, and chronic kidney disease. Smoking contributes to PAD two to three times more than cardiovascular disease (Rooke et al., 2011). The resting ABI is the primary method for establishing a PAD diagnosis (Skelly and Cifu, 2015). The ABI is a simple, non-invasive test using equipment readily available in a primary care clinic. Education and training for primary care providers and nurses in rural clinics can provide access to this test for rural communities decreasing commute time and increasing early detection and intervention for PAD. The purpose of this project was to increase awareness of PAD and ABI screening in a rural primary care clinic, and to increase screening of PAD utilizing the ABI test. Education was given to providers at a rural primary care clinic as well as to clinic registered nurses. Nurse education focused on PAD overview, ABI technique and calculation, and results reporting. Provider education focused on PAD overview, ABI screening guidelines, benefits of screening, barriers, and further referrals and imaging studies. ABI screening was offered to high-risk patients as part of their preventative Medicare Annual Wellness Visit (AWV). Results of the project demonstrated increased provider knowledge and competence through education. A post-education survey resulted in a positive impression from ABI screening citing “early identification” and “early intervention” as the predominant benefits. ABI screening results identified three out of 14 (21.4%) patients with a positive screen. All of the patients with positive results had a history of smoking affirming the significant effects of smoking in PAD.