Frequency of asymptomatic peripheral arterial disease in patients entering the department of general and internal medicine of a general-care hospital.
BACKGROUND: The fact that a high prevalence of asymptomatic peripheral arterial disease (PAD) in the population has repeatedly been noted in recent years, without there being data as to how often asymptomatic PAD has to be anticipated in inpatients treated for divergent internal diseases led us now to performing a screening study in a general-care hospital. PATIENTS AND METHODS: The study population consisted of 990 patients (51.8% women, 48.2% men) with a mean age of 65.2 years (40-93 years) who had to be treated in a hospital for various internal diseases in the period from January 1994 to January 1995. Their case histories were taken, and their clinical findings and the ankle/brachial indices as calculated from Doppler ultrasonographic measurements of the systolic pressures in the malleolar and brachial arteries were used to ascertain how many of the patients presented with asymptomatic and symptomatic PAD. Further the frequency of risk factors (smoking, hypertension, diabetes mellitus, lipid disorders) was recorded for either patient group. RESULTS: The study showed that 6% of the 990 patients suffered from symptomatic PAD and that of the remaining 931 patients, 43.7% were diagnosed, on the basis of the ankle/brachial index (ABI) (< or = 0.9), to have asymptomatic PAD, while 56.3% showed no indication of PAD. CONCLUSIONS: The high number of cases of asymptomatic PAD among inpatients who underwent internal treatment--a percentage well above the figures published so far for outpatients--allows the conclusion that the determination of the ABI is well suited to screen patients older than 50 years even in a hospital setting so that early secondary prophylaxis can be initiated.