Automated ankle-brachial pressure index measurement by clinical staff for PAD diagnosis in non-diabetic and diabetic patients

Abstract

Objective: Peripheral arterial disease (PAD) is a prognostic marker in cardiovascular disease. The use of Doppler ankle brachial pressure index (Dop-ABI) for PAD diagnosis is limited because of time, require training and costs. We assessed automated measurement of ABI (Osc-ABI) by nurses and clinical staff.

Research Design and Methods: Clinical staff measured Osc-ABI with an automated oscillometric device in 146 patients (83 with diabetes) at the time of Dop-ABI measurement and ultrasound evaluation.

Results: ABI was obtained in most legs (Dop-ABI: 98% Osc-ABI: 95.5%). Dop- and Osc-ABI were significantly related in diabetic and non-diabetic patients with good agreement over a wide range of values. When Dop-ABI ≤0.90 was used as the gold standard for PAD, Receiver-Operating Characteristic Curve analysis showed that PAD was accurately diagnosed with Osc-ABI in diabetic patients. When ultrasound-defined PAD, Dop-ABI had better diagnostic performance than Osc-ABI in the whole population, and in diabetic patients (p=0.026). Both methods gave similar results in non-diabetic patients. The cut-off values for the highest sensitivity and specificity for PAD screening were 1.0 to 1.1, respectively. Estimation of cost with the French medical care system fees showed a potential reduction by 3 of the screening procedure.

Conclusions: PAD screening could be improved by using Osc-ABI measured by clinical staff with the benefit of a greater cost-effectiveness, but at the expense of lower diagnostic performance in diabetic patients.