Underdiagnosis of peripheral arterial disease in the spanish population. ARTPER study

Background and objectives: Although peripheral arterial disease (PA) is an important clinical marker of cardiovascular morbimortality, the rate of under-diagnosis is unknown. Our aimed to know the proportion of patients underdiagnosed of PA and the associated factors. Patients and methods: 3786 patients > 49 years old, randomly selected, were studied. PA was diagnosed by means of the ankle-brachial index (ABI < 0, 9). Underdiagnosed was considered when ABI < 0,9 and when they were not diagnosed of PA in the clinical record. We also determined the presence of intermittent claudication (IC) defined by Edinburgh's questionnaire. Results: 7,6% had an ABI < 0, 9 (IC95% 6,7-8, 4). Of these patients 80.7%. were underdiagnosed, although the 29.3% had IC. PA underdiagnosis was low in current smokers or former smokers (OR 0.20; IC95% 0,07-0,59), if IC (OR 0.40; IC95% 0,18-0,89), if ABI between < 0.7 and 0.5 (OR 0.36; IC95% 0,16-0,81) or < 0,5 (OR 0,04; IC95 % 0,01-0,20), being higher in > 70 years (OR 3,12; IC95% 1,12-8,67). Conclusions: PA underdiagnosis is high, especially in old patients. It is necessary to reach consensus criteria for the practice of the ABI in the general population. (C) 2009 Elsevier Espana, S.L. All rights reserved.