Abstract 13108: Socioeconomic Barriers to the Diagnosis of Peripheral Arterial Disease
Objectives: To identify risk factors and barriers associated with the underdiagnosis of peripheral arterial disease (PAD).
Background: PAD is a highly prevalent condition that is recognized as a coronary heart disease equivalent, and is associated with significantly elevated rates of adverse cardiovascular (CV) events. Current guidelines recommend establishing the diagnosis of PAD in at-risk individuals. Despite this, PAD frequently goes undiagnosed and these individuals go untreated. Studies identifying the barriers to PAD recognition are limited.
Methods: The ankle-brachial index (ABI) was calculated in 1,656 subjects undergoing non-emergent coronary angiography in the GenePAD study. PAD was defined by an ABI <0.9. Clinical and psychosocial demographics were collected at baseline and subjects were followed prospectively for mortality and CV outcomes over a period of 5.0 (IQR=4.0-6.3) years. 207 subjects with undiagnosed PAD were identified.
Results: Despite being evaluated by clinical cardiologists, 67.8% of patients identified as having PAD in this study were previously undiagnosed. Compared to patients without PAD, the undiagnosed PAD cohort was older, had higher rates of several cardiovascular comorbidities, and were more likely to have major adverse cardiovascular events (MACE) at follow up (P < 0.03 for all). Additionally, several socioeconomic disparities were noted, including lower income (P=.004) and education levels (P<.001), and higher rates of social isolation (19 vs. 11.9%; P=.027) and depression (P=0.034) amongst those with undiagnosed PAD. Patients with undiagnosed PAD were also more likely to be of the black race. Undiagnosed PAD patients more frequently report claudication symptoms (50 vs. 16%; P<.001) and lower Walking Impairment Questionnaire (WIQ) scores, than the no-PAD cohort.
Conclusion: The prevalence of undiagnosed PAD patients is high, even when under the care of a cardiovascular specialist. Compared to subjects without PAD, undiagnosed PAD patients have higher rates of traditional cardiovascular risk factor, and also have a socioeconomic profile that may represent a barrier to diagnosis. Contrary to dogma, these subjects will report claudication and impaired walking ability, when queried.
- © 2013 by American Heart Association, Inc.