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Diagnosis and Treatment of Peripheral Arterial Disease Compared with Other Atherosclerotic Vascular Diseases in a University Primary Care Clinic
  1. Hassan M. Ismail,
  2. Kyoo Jackson,
  3. Daniel Smith
  1. 1From the Department of Internal Medicine (H.M.I., K.J., D.S.), East Tennessee State University/James Quillen College of Medicine, Johnson City, TN
  1. Address correspondence to: Hassan M. Ismail, MD, MPH, FACP, Department of Internal Medicine, East Tennessee State University/James Quillen College of Medicine, 325 N. State of Franklin Road, 2nd Floor, Johnson City, TN 37604; tel: 423-439-7280; fax: 423-439-8110; e-mail: ismail{at}


Background Despite the fact that peripheral arterial disease (PAD) significantly increases the risk of cardiovascular mortality, it is significantly underdiagnosed and undertreated. The purpose of this study was to evaluate the practice at a northeast Tennessee university primary care clinic regarding the diagnosis and treatment of PAD.

Methods A retrospective medical record survey was conducted to evaluate practice patterns in diagnosing and treating PAD in a university primary care clinic. A clinic population of 711 patients was selected using International Classification of Diseases-9 codes for coronary artery disease (CAD), cerebovascular disease (CVD), and/or PAD. A sample of 180 patients (25.3%) was randomly selected using a systematic statistical method. Of these, 125 patients met the diagnostic criteria for CAD, CVD, and/or PAD. The study covered a 3-year period, from July 2001 until June 2004. Demographic and other data, including the use of antiplatelet therapy, were collected.

Results One hundred ten patients met all of the inclusion and exclusion criteria. Thirty-nine percent were males, and 61% were females. Overall, 79% had CAD, 53% had CVD, and 25% had PAD. Almost half of the patients had some combination of these. Only about 2% had PAD only compared with 36% with CAD only and 17% with CVD only. Although the prevalence of CAD and CVD (among other atherosclerotic vascular diseases) in our clinic was comparable to national figures, the prevalence of PAD was significantly lower (p = .004). The overall use of any antiplatelet agent was 84.2% for patients with only CAD and 80% for only CVD. There was not an adequate number of patients with only PAD to evaluate the use of antiplatelet therapy in this group.

Conclusion The low prevalence of PAD only (most PAD patients had coexisting CAD and CVD) indicates that PAD is underdiagnosed at our clinic. There was suboptimal use of aspirin and other antiplatelet drugs among patients with atherosclerotic vascular disease.

Key Words
  • peripheral arterial disease (PAD)
  • coronary artery disease (CAD)
  • cerebrovascular disease (CVD)
  • The San Diego Artery study
  • The PAD Awareness
  • Risk and Treatment: New Resources for Survival (PARTNERS)
  • atherosclerotic vascular disease
  • clopidogrel versus aspirin in patients at risk of ischemic events (CAPRIE)
  • The prospective study of Aronow and Ahn
  • ankle-branchial index (ABI)
  • Antiplatelet therapy
  • Canadian health system or the U.S. Veterans Affairs (VA) system
  • The Cardiac Hospitalization Atherosclerosis Management Program (CHAMP)

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