Session number: 1140
Abstract title: The Prevalence of Intermittent Claudication in an Ethnically Diverse Bilingual Population
Author(s):
TC Collins - Houston Center for Quality of Care and Utilization Studies, Baylor College of Medicine
N Petersen - Houston Center for Quality of Care and Utilization Studies, Baylor College of Medicine
M Suarez-Almazor - Houston Center for Quality of Care and Utilization Studies, Baylor College of Medicine
Objectives: Objective. To determine the prevalence of intermittent claudication among Non-Hispanic White, African American, and Hispanic (both English and Spanish speaking) patients screened for peripheral arterial disease (PAD).
Methods: Methods. We screened patients > 50 years of age PAD from the Houston VA Medical Center and the Harris County Hospital District outpatient clinics. PAD was diagnosed by the bedside blood pressure measurement, the ankle-arm index (AAI; a level < 0.9 was defined as disease). Patients also completed a questionnaire to ascertain leg symptoms related to compromised blood flow, the San Diego Claudication Questionnaire (SDCQ). The SDCQ can be used to classify PAD patients as having no leg symptoms, atypical leg symptoms, or typical symptoms of intermittent claudication. The questionnaire was translated into Spanish by a team of bilingual investigators. The translation process involved two forward and two backward translations prior to the final Spanish version. The research assistants were fluent in English and Spanish.
Results: Results. We enrolled 403 patients (136 Non-Hispanic Whites, 136 African Americans 50 Hispanic English-speaking and 81 Hispanic Spanish-speaking). The mean ages of the patients by race were 64.11 SD 0.84 for Non-Hispanic Whites, 63.55 SD 0.61 for African Americans, 63.24 SD 0.98 for Hispanic English-speaking, and 58.18 SD 1.74 for Hispanic Spanish-speaking. Sixty-seven patients screened positive for PAD. Thus, the prevalence of PAD among the entire cohort was 16.6%. Among the 67 patients who had an AAI <0.9, 5 (7.5%) had symptoms of intermittent claudication, 37 (55.2%) had atypical leg symptoms, and 25 (37.3%) had no leg symptoms.
Conclusions: Conclusion. PAD is a prevalent chronic illness most commonly affecting patients over the age of 60 years. Many patients with this disease either have atypical symptoms or no symptoms at all. The low prevalence of intermittent claudication is concerning in that the diagnosis of PAD may be missed if physicians wait for patients to present with typical symptoms of intermittent claudication prior to testing for this disease. As patients with PAD are at increased risk for myocardial infarction, cerebrovascular accidents, and limb loss, further research should focus on the impact, within a primary care setting, of PAD screening on reducing cardiovascular events and limb loss.
Impact statement: PAD is likely underdiagnosed in patients within a primary care setting.