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Peripheral arterial disease — a cardiovascular time bomb
Jill Belch
Vascular Diseases Research Unit, The Institute of Cardiovascular Research, University of Dundee, Ninewells Hospital C and Medical School, Dundee, DD1 9SY, Scotland, J.J.F.Belch{at}Dundee.ac.uk
Gerry Stansby
The Northern Vascular Unit, Freeman Hospital, Newcastle Upon Tyne, NE7 7DN, UK
Cliff Shearman
Southampton University Hospitals NHS Trust, Tremona Road, Southampton, Hampshire, SO16 6YD, UK
Julie Brittenden
Department of Surgery, Polwarth Building, University of Aberdeen, Aberdeen, AB25 2ZN, Scotland
Shiela Dugdill
Northern Vascular Centre, Freeman Hospital, Freeman Road, High Heaton, Newcastle Upon Tyne, NE7 7DN, UK
Gerry Fowkes
Wolfson Unit for Prevention of Peripheral Vascular Disease, University of Edinburgh, EH8 9AG, Scotland
Sarah Jarvis
Richford Gate Medical Practice, Richford Gate Primary Care Centre, Richford Street, London, W6 7HY, UK
Terrie Mccann
The Circulation Foundation, 35-43 Lincoln's Inn Fields, London WC2A 3PE
Andrew Mimnagh
Eastview Surgery, 81 Crosby Road North, Waterloo, Liverpool, L22 4QD, UK
David Monkman
East Barnet Health Centre, 149 East Barnet Road, New Barnet, Herts, EN4 8QZ, UK
Jonathan Morrell
21 Beaconsfield Road, Hastings, East Sussex, TN34 3TW, UK
Peripheral arterial disease (PAD) is a reliable marker of future vascular disease and is a substantial public health issue. In Europe and North America, 27 million people are estimated to have PAD, and in the UK around 100,000 people are diagnosed every year. People with PAD are six times more likely to die from cardiovascular disease within 10 years than people without PAD. Evidence suggests that aggressive risk factor management will prevent many premature deaths and associated morbidity. Therefore, it is vital to identify patients and initiate effective management strategies swiftly. However, whilst 40% of PAD patients have symptomatic disease ranging from intermittent claudication to critical limb ischaemia, around 60% are asymptomatic. As a result of the low rates of detection PAD is underdiagnosed and undertreated in the UK. The gravity of the problem has prompted the formation of professional bodies to address this situation through the development of national clinical guidelines. Indeed, with the focus of general practitioners' work covered by the quality and outcomes framework in the General Medical Services (GMS) contract, many consider that the inclusion of PAD in the GMS contract is critical to raising awareness and improving the management of PAD in primary care.
Key Words: cardiovascular disease peripheral arterial disease quality and outcomes framework.
References
- The Coronary Heart Disease National Service Framework - Shaping the Future, Progress Report for 2006. Standards 3 & 4: Preventing CHD in high risk. Department of Health 2006.
- JBS2: Joint British Societies' guidelines on prevention of cardiovascular disease in clinical practice. http://heart.bmjjournals.com/cgi/reprint/91/suppl_5/v1?ijkey=PbMmm2L5wGIMU&keytype=ref&siteid=bmjjournals (Accessed February 2006).
- Belch J., Topol E., Agnelli G., Bertrand M. Critical issues in peripheral arterial disease detection and management. Arch Intern Med 2003;163:884-92.[Free Full Text]
- Norgren L., Hiatt WR, Dormandy JA et al. Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC II). Eur J Vasc Surg Vol 33, Supplement 1, 2007.
- Appraisal Consultation Document: Clopidogrel and modified-release dipyridamole in the secondary prevention of occlusive vascular events.http://www.nice.org.uk/page.aspx?o=105159 (Accessed September 2007).
- Fowkes FG, Housley E., Cawood EHH et al. Edinburgh Artery Study: prevalence of asymptomatic and symptomatic peripheral arterial disease in the general population. Int J Epidemiol 1991;20:384-92.[Abstract/Free Full Text]
- Dumville JC, Lee AJ, Smith FB, Fowkes FG The health-related quality of life of people with peripheral arterial disease in the community: the Edinburgh Artery Study. Br J Gen Prac 2004;54:826-31.[Web of Science][Medline]
[Order article via Infotrieve]
- Aronow WS, Ahn C. Prevalence of coexistence of coronary artery disease, peripheral arterial disease, and atherothrombotic brain infarction in men and women? 62 years of age. Am J Cardiol 1994;74:64-5.[CrossRef][Web of Science][Medline]
[Order article via Infotrieve]
- Tierney S., Fennessy F., Hayes DB ABC of arterial and vascular disease. Secondary prevention of peripheral vascular disease. BMJ 2000;320: 1262-5.[Free Full Text]
- Criqui MH, Langer RD, Fronek A. et al. Mortality over a period of 10 years in patients with peripheral arterial disease. N Engl J Med 1992;326: 381-6.[Abstract]
- Steg PG, Bhatt DL, Wilson PWF et al. R. One-year cardiovascular event rates in outpatients with atherothrombosis. JAMA 2007;297:1197-206.[Abstract/Free Full Text]
- American Cancer Society, Cancer Facts and Figures - 1997 http://www.cancer.org/downloads/STT/F&F97.pdf (Accessed January 2007).
- Mister R., Flather M., Delahunty N. et al. Coronary heart disease in patients with intermittent claudication [abstract]. Heart 2004;Suppl:A81.
- Peripheral Arterial Diseases Antiplatelet Consensus Group. Antiplatelet therapy in peripheral arterial disease. Consensus statement. Eur J Vasc Endovasc Surg 2003;26:1-16.[Medline]
[Order article via Infotrieve]
- Antithrombotic Trialists' Collaboration. Collaborative meta-analysis of randomised trials of antiplatelet therapy for prevention of death, myocardial infarction, and stroke in high risk patients. BMJ 2002;324: 71-86.[Abstract/Free Full Text]
- Collins R., Armitage J., Parish S., Sleight P., Peto R.; Heart Protection Study placebo controlled trial. Lancet 2004;363:757-67. Collaborative Group. MRC/BHF Heart Protection Study of cholesterol lowering with simvastatin in 20 536 high-risk individuals: a randomised placebo controlled trial. Lancet 2004;363:757-67.[CrossRef][Web of Science][Medline]
[Order article via Infotrieve]
- Gent M., et al. Effectiveness of Clopidogrel Versus Aspirin in Preventing Acute Myocardial Infarction in Patients With Symptomatic Atherothrombosis (CAPRIE Trial). Lancet 1996;348:1329-39.[CrossRef][Web of Science][Medline]
[Order article via Infotrieve]
- Scottish Intercollegiate Guideline Network (SIGN). Diagnosis and management of peripheral arterial disease. A National Clinical Guideline. October 2006.
- Grundy S., Pasternak R., Greenland P. et al. Assessment of Cardiovascular Risk by Use of Multiple-Risk-Factor Assessment Equations. A Statement for Healthcare Professionals from the American Heart Association and the American College of Cardiology. Circulation 1999;100:1481-92.[Free Full Text]
- Duvall WL, Vorchheimer DA Multi-bed vascular disease and atherothrombosis: scope of the problem. J Thromb Thrombolysis 2004; 17:51-61.[CrossRef][Web of Science][Medline]
[Order article via Infotrieve]
- Michael H., Criqui Vargo V., Denemberg JO et al. Ethnicity and Peripheral Arterial Disease: The San Diego Population Study. Circulation 2005;112;2703-07.[Abstract/Free Full Text]
- Belch J., Stansby G. et al. Peripheral arterial disease: still on the periphery? BMJ 2006;532:1213.
- Target PAD Group Management Algorithm for primary care. August 2006.
The British Journal of Diabetes & Vascular Disease, Vol. 7, No. 5,
236-239 (2007)
DOI: 10.1177/14746514070070050701

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J. Belch and G. Stansby
Peripherial arterial disease indicators should be included in Quality Outcomes Frameworks
The British Journal of Diabetes & Vascular Disease,
January 1, 2008;
8(1):
5 - 6.
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