A systematic review for the screening for peripheral arterial disease in asymptomatic patients

Fares Alahdab, Amy T. Wang, Tarig A. Elraiyah, Rafael D. Malgor, Adnan Z. Rizvi, Melanie A. Lane, Larry J. Prokop, Victor Manuel Montori, Michael S. Conte, Mohammad H Murad

Research output: Contribution to journalArticle

38 Citations (Scopus)

Abstract

Background Peripheral arterial disease (PAD) is common and associated with significant morbidity and mortality. PAD can be detected through a noninvasive measurement of the ankle-brachial index (ABI). Methods We conducted a systematic review of several electronic bibliographic databases for studies that evaluated ABI as a screening test for PAD in asymptomatic individuals. We conducted random-effects meta-analysis, reporting pooled hazard ratios (HRs) when appropriate. Results We included 40 individual studies, 2 systematic reviews, and 1 individual-patient data meta-analysis. We found no studies comparing ABI screening with no screening in terms of patient-important outcomes (mortality, amputations). The yield of PAD screening averaged 17% (range, 1%-42%) and was 1% to 4% in lower risk populations. Patients with PAD had higher adjusted risk of all-cause mortality (HR, 2.99; 95% confidence interval, 2.16-4.12) and of cardiovascular mortality (HR, 2.35; 95% confidence interval, 1.91-2.89). Data on benefits, harms, and cost-effectiveness of screening were limited; however, ABI screening was associated with additional prognostic information and risk stratification for heart disease. The overall quality of evidence supporting screening was low. Conclusions The current available evidence demonstrates that PAD is common in patients with multiple cardiovascular risk factors and is associated with significant morbidity and mortality, but it does not support the benefit of routine ABI screening.

Original languageEnglish (US)
Pages (from-to)42S-53S
JournalJournal of Vascular Surgery
Volume61
Issue number3
DOIs
StatePublished - Mar 1 2015

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Peripheral Arterial Disease
Ankle Brachial Index
Mortality
Cost-Benefit Analysis
Meta-Analysis
Bibliographic Databases
Confidence Intervals
Morbidity
Amputation
Heart Diseases
Population

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

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A systematic review for the screening for peripheral arterial disease in asymptomatic patients. / Alahdab, Fares; Wang, Amy T.; Elraiyah, Tarig A.; Malgor, Rafael D.; Rizvi, Adnan Z.; Lane, Melanie A.; Prokop, Larry J.; Montori, Victor Manuel; Conte, Michael S.; Murad, Mohammad H.

In: Journal of Vascular Surgery, Vol. 61, No. 3, 01.03.2015, p. 42S-53S.

Research output: Contribution to journalArticle

Alahdab, F, Wang, AT, Elraiyah, TA, Malgor, RD, Rizvi, AZ, Lane, MA, Prokop, LJ, Montori, VM, Conte, MS & Murad, MH 2015, 'A systematic review for the screening for peripheral arterial disease in asymptomatic patients', Journal of Vascular Surgery, vol. 61, no. 3, pp. 42S-53S. https://doi.org/10.1016/j.jvs.2014.12.008
Alahdab, Fares ; Wang, Amy T. ; Elraiyah, Tarig A. ; Malgor, Rafael D. ; Rizvi, Adnan Z. ; Lane, Melanie A. ; Prokop, Larry J. ; Montori, Victor Manuel ; Conte, Michael S. ; Murad, Mohammad H. / A systematic review for the screening for peripheral arterial disease in asymptomatic patients. In: Journal of Vascular Surgery. 2015 ; Vol. 61, No. 3. pp. 42S-53S.
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AU - Lane, Melanie A.

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N2 - Background Peripheral arterial disease (PAD) is common and associated with significant morbidity and mortality. PAD can be detected through a noninvasive measurement of the ankle-brachial index (ABI). Methods We conducted a systematic review of several electronic bibliographic databases for studies that evaluated ABI as a screening test for PAD in asymptomatic individuals. We conducted random-effects meta-analysis, reporting pooled hazard ratios (HRs) when appropriate. Results We included 40 individual studies, 2 systematic reviews, and 1 individual-patient data meta-analysis. We found no studies comparing ABI screening with no screening in terms of patient-important outcomes (mortality, amputations). The yield of PAD screening averaged 17% (range, 1%-42%) and was 1% to 4% in lower risk populations. Patients with PAD had higher adjusted risk of all-cause mortality (HR, 2.99; 95% confidence interval, 2.16-4.12) and of cardiovascular mortality (HR, 2.35; 95% confidence interval, 1.91-2.89). Data on benefits, harms, and cost-effectiveness of screening were limited; however, ABI screening was associated with additional prognostic information and risk stratification for heart disease. The overall quality of evidence supporting screening was low. Conclusions The current available evidence demonstrates that PAD is common in patients with multiple cardiovascular risk factors and is associated with significant morbidity and mortality, but it does not support the benefit of routine ABI screening.

AB - Background Peripheral arterial disease (PAD) is common and associated with significant morbidity and mortality. PAD can be detected through a noninvasive measurement of the ankle-brachial index (ABI). Methods We conducted a systematic review of several electronic bibliographic databases for studies that evaluated ABI as a screening test for PAD in asymptomatic individuals. We conducted random-effects meta-analysis, reporting pooled hazard ratios (HRs) when appropriate. Results We included 40 individual studies, 2 systematic reviews, and 1 individual-patient data meta-analysis. We found no studies comparing ABI screening with no screening in terms of patient-important outcomes (mortality, amputations). The yield of PAD screening averaged 17% (range, 1%-42%) and was 1% to 4% in lower risk populations. Patients with PAD had higher adjusted risk of all-cause mortality (HR, 2.99; 95% confidence interval, 2.16-4.12) and of cardiovascular mortality (HR, 2.35; 95% confidence interval, 1.91-2.89). Data on benefits, harms, and cost-effectiveness of screening were limited; however, ABI screening was associated with additional prognostic information and risk stratification for heart disease. The overall quality of evidence supporting screening was low. Conclusions The current available evidence demonstrates that PAD is common in patients with multiple cardiovascular risk factors and is associated with significant morbidity and mortality, but it does not support the benefit of routine ABI screening.

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