The US Preventive Services Task Force found that the current evidence on the use of the resting ankle-brachial index as a screening test for peripheral artery disease is insufficient to assess the balance of benefits and harms of screening, according to a recently published report.
The review, published in the Annals of Internal Medicine, focused on resting ankle-brachial index (ABI) as the sole screening method; the diagnostic performance of ABI testing in primary care populations, unselected populations and asymptomatic populations; the predictive value of ABI testing for major cardiovascular disease (CVD) and peripheral artery disease (PAD)-specific morbidity in patients with asymptomatic or minimally symptomatic PAD.
The task force found more harms than benefits came from testing for PAD with ABI screening, including false-positive results, exposure to gadolinium or contrast dye if magnetic resonance angiography or computed tomography angiography is used to confirm diagnosis, anxiety, labeling and opportunity costs. Early treatment of PAD or treatment due to false-positive testing results was associated with treatment of unnecessary or higher dose medications, as well as their resulting adverse effects. Reclassification of patients to a lower risk category due to a normal ABI also increased the risks associated with discontinuing medications known to be effective in patients with established coronary artery disease.
The USPSTF suggested that large, population-based randomized trials are needed to determine whether screening for PAD with the ABI improves clinical outcomes. Future studies also should address the large population of patients who are at an increased risk for PAD and are not already receiving cardiovascular risk reduction interventions, as well as determine whether aggressive modification of risk factors in patients with multiple atherosclerotic risk factors reduces the incidence of symptomatic PAD.
For more information:
Moyer VA. Ann Intern Med. 2013; 159:342-348.
Disclosures: Moyer reports receiving financial support from the Agency for Healthcare Research and Quality.