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Arterial disease of the leg frequently overlooked in patients with heart disease
Date:4/28/2009

symptoms of the disease. "The combination of physician lack of awareness and lack of symptoms among patients results in failure to diagnose PAD, even in patients who are at high risk," the researchers state. "Furthermore, clinical evaluation alone often lacks the sensitivity and specificity to optimally identify PAD particularly in less advanced stages and in hospitalized patients with CAD."

The study also found that previously missed PAD was more frequent in older patients and women, which goes against the conventional wisdom that PAD is more prevalent in men and suggests that PAD is more frequently overlooked in women than men in outpatient settings. In addition, the study showed that patients with PAD had a more severe form of CAD, which may account for the worse outcome of heart patients who also have PAD compared to those who do not. The authors note that "making a diagnosis of PAD in a patient with CAD should prompt the clinician to be more aggressive with risk factor intervention, foot protection and a high clinical index of suspicion for progressive PAD symptoms," adding that these patients should be viewed as exceptionally high risk.

They also note that establishing an early diagnosis of PAD promotes the preservation of functional status in the lower limbs, which is particularly important in patients CAD, since PAD may limit active participation in cardiovascular rehabilitation following coronary interventions. Many physicians cite the lack of space, time and resources as barriers to implementing a systematic PAD screening program, however new guidelines by the American Heart Association and the American College of Cardiology advocate screening for PAD in patients with CAD. The authors conclude that their findings present a compelling argument that screening for PAD should become standard of care in these patients.


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Contact: Sean Wagner
medicalnews@bos.blackwellpublishing.net
781-388-8550
Wiley-Blackwell
Source:Eurekalert

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