Original Article

Ankle Brachial Index Measurement in Primary Care Setting: How Long Does It Take?

Authors: Tamera Pearson PhD, ACNP, RN, Gary Kukulka PhD, Zia Ur Rahman MD

Abstract

Background:Peripheral arterial disease (PAD) affects over 8 million people in the United States and has been found to be associated with an increased incidence of coronary and carotid artery disease. The ankle brachial index (ABI) measurement is a highly specific noninvasive screening and diagnostic test for PAD, but is rarely performed in primary care office settings. This study sought to determine the actual performance time involved in completing an ABI in a primary care office.Methods:Data were collected by one provider on a convenience sample of women who met the inclusion criteria. The time was recorded at the beginning and upon the completion of the ABI procedure for each patient. Analysis of the time data was completed and barriers to performing the ABI were recorded by the provider.Results:The average time to complete an ABI was 5 minutes, with a range of 3-11 minutes. In 83.8% of patient encounters, the ABI procedure took less than 6 minutes to complete. Barriers identified by the provider included the additional time needed to explain the test and assist patients into the proper testing position.Conclusions:The actual performance time for an ABI in a primary care setting takes an average of 5 minutes, but additional time may be required for patient preparation and education. With proper scheduling and training, the ABI can be completed in a timely manner. The ABI is an important screening/diagnostic test that can be performed in primary care and potentially impact patient treatment plans.

This content is limited to qualifying members.

Existing members, please login first

If you have an existing account please login now to access this article or view purchase options.

Purchase only this article ($25)

Create a free account, then purchase this article to download or access it online for 24 hours.

Purchase an SMJ online subscription ($75)

Create a free account, then purchase a subscription to get complete access to all articles for a full year.

Purchase a membership plan (fees vary)

Premium members can access all articles plus recieve many more benefits. View all membership plans and benefit packages.

References

References1. Ankle Brachial Index Collaboration; Fowkes FG, Murray GD, Butcher I, et al. Ankle brachial index combined with Framingham risk score to predict cardiovascular events and mortality: a meta-analysis. JAMA 2008;300:197-208.Ankle Brachial Index CollaborationFowkesFG]]MurrayGD]]ButcherI&etal;Ankle brachial index combined with Framingham risk score to predict cardiovascular events and mortality: a meta-analysis.JAMA2008300197-2082. American Heart Association (n.d.) Heart Disease and Stroke Statistics - 2009 Update, At a Glance Version. Available at: http://www.americanheart.org.3. Golomb BA, Dang TT, Criqui MH. Peripheral arterial disease: morbidity and mortality implications. Circulation 2006;114:688-699.GolombBA]]DangTT]]CriquiMHPeripheral arterial disease: morbidity and mortality implications.Circulation2006114688-6994. Filippella M, Lillaz E, Ciccarelli A, et al. Ankle brachial pressure index usefulness as predictor factor for coronary heart disease in diabetic patients. J Endocrinol Invest 2007;30:721-725.FilippellaM]]LillazE]]CiccarelliA&etal;Ankle brachial pressure index usefulness as predictor factor for coronary heart disease in diabetic patients.J Endocrinol Invest200730721-7255. Lee AJ, Price JF, Russell MJ, et al. Improved prediction of fatal myocardial infarction using the ankle brachial index in addition to conventional risk factors: the Edinburgh artery study. Circulation 2004;110:3075-3080.LeeAJ]]PriceJF]]RussellMJ&etal;Improved prediction of fatal myocardial infarction using the ankle brachial index in addition to conventional risk factors: the Edinburgh artery study.Circulation20041103075-30806. Enoch A, Ijeoma A. The role of ankle-brachial index as a screening test for coronary artery disease in the Hispanic population. South Med J 2008;101:1117-1120.EnochA]]IjeomaAThe role of ankle-brachial index as a screening test for coronary artery disease in the Hispanic population.South Med J20081011117-11207. Doobay AV, Anand SS. Sensitivity and specificity of the ankle-brachial index to predict future cardiovascular outcomes: a systematic review. Arterioscler Thromb Vasc Biol 2005;25:1463-1469.DoobayAV]]AnandSSSensitivity and specificity of the ankle-brachial index to predict future cardiovascular outcomes: a systematic review.Arterioscler Thromb Vasc Biol2005251463-14698. Price JF, Tzoulaki I, Lee AJ, et al. Ankle brachial index and intima media thickness predict cardiovascular events similarly and increased prediction when combined. J Clin Epidemiol 2007;60:1067-1075.PriceJF]]TzoulakiI]]LeeAJ&etal;Ankle brachial index and intima media thickness predict cardiovascular events similarly and increased prediction when combined.J Clin Epidemiol2007601067-10759. McDermott MM. The magnitude of the problem of peripheral arterial disease: epidemiology and clinical significance. Cleve Clin J Med 2006;73(Suppl 4):S2-S7.McDermottMMThe magnitude of the problem of peripheral arterial disease: epidemiology and clinical significance.Cleve Clin J Med200673S2-S710. Khan NA, Rahim SA, Anand SS, et al. Does the clinical examination predict lower extremity peripheral arterial disease? JAMA 2006;295:536-546.KhanNA]]RahimSA]]AnandSS&etal;Does the clinical examination predict lower extremity peripheral arterial disease?JAMA2006295536-54611. Mohler ER III, Treat-Jacobson D, Reilly MP, et al. Utility and barriers to performance of the ankle-brachial index in primary care practice. Vasc Med 2004;9:253-260.MohlerERIII]]Treat-JacobsonD]]ReillyMP&etal;Utility and barriers to performance of the ankle-brachial index in primary care practice.Vasc Med20049253-26012. Shaw LJ, Bairey Merz CN, Pepine CJ, et al. Insights from the NHLBI-sponsored Women’s Ischemia Syndrome Evaluation (WISE) study: Part I: gender differences in traditional and novel risk factors, symptom evaluation, and gender-optimized diagnostic strategies. J Am Coll Cardiol 2006;47(3 suppl):S4-S20.ShawLJ]]Bairey MerzCN]]PepineCJ&etal;Insights from the NHLBI-sponsored Women’s Ischemia Syndrome Evaluation (WISE) study: Part I: gender differences in traditional and novel risk factors, symptom evaluation, and gender-optimized diagnostic strategies.J Am Coll Cardiol200647S4-S2013. Bairey Merz CN, Shaw LJ, Reis SE, et al. Insights from the NHLBI-sponsored Women’s Ischemia Syndrome Evaluation (WISE) study: Part II: gender differences in presentation, diagnosis, and outcome with regard to gender-based pathophysiology of atherosclerosis and macrovascular and microvascular coronary disease. J Am Coll Cardiol 2006;47(3 suppl):S21-S29.Bairey MerzCN]]ShawLJ]]ReisSE&etal;Insights from the NHLBI-sponsored Women’s Ischemia Syndrome Evaluation (WISE) study: Part II: gender differences in presentation, diagnosis, and outcome with regard to gender-based pathophysiology of atherosclerosis and macrovascular and microvascular coronary disease.J Am Coll Cardiol200647S21-S2914. Caruana MF, Bradbury AW, Adam DJ. The validity, reliability, reproducibility and extended utility of ankle to brachial pressure index in current vascular surgical practice. Eur J Vasc Endovasc Surg 2005;29:443-451.CaruanaMF]]BradburyAW]]AdamDJThe validity, reliability, reproducibility and extended utility of ankle to brachial pressure index in current vascular surgical practice.Eur J Vasc Endovasc Surg200529443-45115. Hirsch AT, Haskal ZJ, Hertzer NR, et al. ACC/AHA guidelines for the management of patients with peripheral arterial disease (lower extremity, renal, mesenteric, and abdominal aortic): a collaborative report from the American associations for vascular surgery/society for vascular surgery, society for cardiovascular angiography and interventions, society for vascular medicine and biology, society of interventional radiology, and the ACC/AHA task force on practice guidelines (writing committee to develop guidelines for the management of patients with peripheral arterial disease)-summary of recommendations. J Vasc Interv Radiol 2006;17:1383-1397.HirschAT]]HaskalZJ]]HertzerNR&etal;ACC/AHA guidelines for the management of patients with peripheral arterial disease (lower extremity, renal, mesenteric, and abdominal aortic): a collaborative report from the American associations for vascular surgery/society for vascular surgery, society for cardiovascular angiography and interventions, society for vascular medicine and biology, society of interventional radiology, and the ACC/AHA task force on practice guidelines (writing committee to develop guidelines for the management of patients with peripheral arterial disease)-summary of recommendations.J Vasc Interv Radiol2006171383-139716. Wilson JF, Laine C, Goldmann D. In the clinic. Peripheral arterial disease. Ann Intern Med 2007;146:ITC3-1-ITC3-16.WilsonJF]]LaineC]]GoldmannDIn the clinic. Peripheral arterial disease.Ann Intern Med2007146ITC3-1-ITC3-1617. Khan S, Cleanthis M, Smout J, et al. Life-style modification in peripheral arterial disease. Eur J Vasc Endovasc Surg 2005;29:2-9.KhanS]]CleanthisM]]SmoutJ&etal;Life-style modification in peripheral arterial disease.Eur J Vasc Endovasc Surg2005292-918. Norman PE, Eikelboom JW, Hankey GJ. Peripheral arterial disease: prognostic significance and prevention of atherothrombotic complications. Med J Aust 2004;181:150-154.NormanPE]]EikelboomJW]]HankeyGJPeripheral arterial disease: prognostic significance and prevention of atherothrombotic complications.Med J Aust2004181150-15419. Oka RK. Peripheral arterial disease in older adults: management of cardiovascular disease risk factors. J Cardiovasc Nurs 2006;21(5 Suppl 1):S15-S20.OkaRKPeripheral arterial disease in older adults: management of cardiovascular disease risk factors.J Cardiovasc Nurs200621S15-S2020. American Diabetes Association. Peripheral arterial disease in people with diabetes. Diabetes Care 2003;26:3333-3341.&NA;American Diabetes Association. Peripheral arterial disease in people with diabetes.Diabetes Care2003263333-334121. Al-Omran M. Knowledge and attitude of physicians in a major teaching hospital towards atherosclerotic risk reduction therapy in patients with peripheral arterial disease. Vasc Health Risk Manag 2007;3:1019-1027.Al-OmranMKnowledge and attitude of physicians in a major teaching hospital towards atherosclerotic risk reduction therapy in patients with peripheral arterial disease.Vasc Health Risk Manag200731019-1027