Diagnosis of peripheral arterial disease in primary care: a survey of general practitioners in England & Ireland

Conference:

SAPC ASM 2021 - virtual

Talk Code:

P1.11.4

Presenter:

Judit Konya

Co-authors:

STJ McDonagh1, P Hayes3, G Abel1, K Boddy1, CE Clark1

Author institutions:

1 University of Exeter Medical School, 2 HEE Kernow Health CIC Training Hub, 3 University of Limerick School of Medicine

Problem

Lower extremity peripheral arterial disease (PAD) represents substantial economic and health care burdens. PAD is poorly understood by patients, and is under-diagnosed, partly due to the variability of symptoms presented. The EuroPAD expert advisory group, convened to raise awareness of PAD, have developed a survey to investigate current general practitioners’ (GPs) approaches to detecting and monitoring PAD throughout Europe. Here we report findings using the English language version from England and the Republic of Ireland (ROI).

Approach

The online survey was distributed between January 2020 and January 2021. We approached GPs by email via Clinical Research Networks, Faculty newsletters for the Royal College of General Practitioners and the RCGP Rural Forum Google Group. We surveyed GPs in England and ROI regarding their approaches to diagnosis and management of people with PAD. Preliminary baseline data are included in this abstract and full analyses and results will be presented at the conference.

Findings

111 surveys were completed (68, England; 43, ROI); GP mean age 45.7 (SD 9.5) years, 78% from urban or semi-rural practices. 77% of GPs reported only palpating lower limb pulses in the presence of symptoms suggesting PAD, and only 20% specifically in patients with cardiovascular risk factors who present with rest pain or claudication. Whilst no differences in clinical approaches between England and ROI were noted, only 25% of English GP practices do not measure ankle-brachial index compared to 55% in ROI (p<0.05). After revascularisation for PAD, 14% of GPs do not regularly follow their patients up. Those who do are more likely to re-refer to vascular specialists when required in England (56%) compared to ROI (29%); p<0.02).

Consequences

Our findings seem to confirm poor awareness of PAD in English and Irish primary care settings, and offer insight into areas of diagnosis and management amenable to intervention. Our results will be merged with other national surveys led by the EuroPAD investigators and contribute to a Europe-wide report that will guide future policy.

Submitted by:

Judit Konya

Funding acknowledgement:

Our survey study has been supported by the Practitioner’s Allowance Grant from the Royal College of General Practitioners Scientific Foundation Board.