Background Despite the fact that peripheral arterial disease (PAD) significantly increases the risk of cardiovascular mortality, it is significantly under-diagnosed and under-treated. The purpose of this study is to evaluate the practice at a northeast Tennessee university primary care clinic in regards to diagnosis and treatment of PAD. Methods: A clinic population of 794 patients was selected using ICD 9 codes for coronary artery disease (CAD), cerebral vascular disease (CVA), and/or PAD. A sample of 125 patients (15.7%) was randomly selected using a systematic statistical method. The study covered a three-year period, from July 2001-June 2004.
Inclusion Criteria 1) Age 35-85; 2) diagnosis of PAD, CAD, or CVA; 3) availability of health insurance and prescription drug coverage; 4) being seen by a physician in the same clinic at least twice a year during the study period.
Exclusion Criteria 1) PAD, CAD, or CVA related to other than atherosclerosis; 2) non-compliance as evidenced by not showing up for appointments, not taking medicines, or refusing diagnostic tests or treatments. Demographic and other data, including the use of antiplatelet therapy, were collected. Epi Info 2002 was used for statistical analysis.
Results A total of 82 patients met all the criteria. 36.6% were males, 63.4% females. 81.7.1% had CAD, 50% had CVA, and 22% had PAD. 9.8% of patients had CAD, CVA, and PAD; 23.2% had CAD and CVA; 9.8% had CAD and PAD; and 1.2% had CVA and PAD. Only 1.2% of patients had only PAD (without CAD or CVA) compared to 39% of only CAD and 15.9% of only CVA. Although the prevalence of CAD and CVA in our clinic was comparable to national figures, the prevalence of PAD was significantly lower (p = .004). 84.2% of patients who had only CAD and 60% of only CVA were on aspirin. However, 10.5% of patients with only CAD and 60% with only CVA were on antiplatelet treatment other than aspirin. The overall utilization of any antiplatelet agent was 84.2% for patients with only CAD and 80% for CVA. There was not an adequate number of patients with only PAD to evaluate the utilization of antiplatelet therapy among this group.
Conclusion The fact that the prevalence of PAD was low and most PAD patients had co-existing CAD and CVA indicates that PAD is under-diagnosed at our clinic. There was sub-optimal utilization of aspirin and other antiplatelet drugs among patients with atherosclerotic vascular disease.
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