Screening for Peripheral Artery Disease and Cardiovascular Disease Risk Assessment With the Ankle–Brachial Index: U.S. Preventive Services Task Force Recommendation Statement
Journal: Annals of Internal Medicine (2013)

ForceT he US Preventive Services Task Force (USPSTF) makes recommendations about the effectiveness of specific clinical preventive services for patients without obvious related signs or symptoms.It bases its recommendations on the evidence of both the benefits and harms of the service and an assessment of the balance.The USPSTF does not consider the costs of providing a service in this assessment.The USPSTF recognizes that clinical decisions involve more considerations than evidence alone.Clinicians should understand the evidence but individualize decision making to the specific patient or situation.Similarly, the USPSTF notes that policy and coverage decisions involve considerations in addition to the evidence of clinical benefits and harms. Summary of Recommendation and EvidenceThe USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for peripheral arterydisease(PAD)andcardiovasculardisease(CVD)riskwiththeanklebrachial index (ABI) in asymptomatic adults (I statement) (Figure 1).See the Clinical Considerations section for suggestions for practice regarding the I statement.IMPORTANCE Peripheral artery disease (PAD) is a manifestation of atherosclerosis in the lower limbs.It can impair walking and, in severe cases, can lead to tissue loss, infection, and amputation.In addition to morbidity directly caused by PAD, patients with PAD are at increased risk for cardiovascular disease (CVD) events, because atherosclerosis is a systemic disease that also causes coronary and cerebrovascular events.OBJECTIVE To update the 2013 US Preventive Services Task Force (USPSTF) recommendation on screening for PAD and CVD risk with the ankle-brachial index (ABI). EVIDENCE REVIEWThe USPSTF reviewed the evidence on whether screening for PAD with the ABI in generally asymptomatic adults reduces morbidity or mortality from PAD or CVD.The current review expanded on the previous review to include individuals with diabetes and interventions that include supervised exercise and physical therapy intended to improve outcomes in the lower limbs.FINDINGS The USPSTF found few data on the accuracy of the ABI for identifying asymptomatic persons who can benefit from treatment of PAD or CVD.There are few studies addressing the benefits of treating screen-detected patients with PAD; 2 good-quality studies showed no benefit of using the ABI to manage daily aspirin therapy in unselected populations, and 2 studies showed no benefit from exercise therapy.No studies addressed the harms of screening, although the potential exists for overdiagnosis, labeling, and opportunity costs.Studies that addressed the harms of treatment showed nonsignificant results.Therefore, the USPSTF concludes that the current evidence is insufficient and that the balance of benefits and harms of screening for PAD with the ABI in asymptomatic adults cannot be determined. CONCLUSIONS AND RECOMMENDATIONThe USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for PAD and CVD risk with the ABI in asymptomatic adults.(I statement)