I would like to comment on the Commentary by Belch et al.1 While a diagnosis of asymptomatic peripheral arterial disease (PAD) by an abnormal ankle-brachial index (ABI) may be prognostically useful, it does not appear to add value to readily available proven diagnostic and therapeutic protocols. Specifically, a good history review should direct one toward claudication and, if properly structured, takes less time than the 10 minutes for the ABI measurement, and is less expensive. Regarding all of the medical therapeutic manipulations suggested if the ABI is abnormal (ie, exercise, lowering lipid levels, treating hypertension and diabetes, using aspirin, and encouraging smoking cessation), shouldn't all of these be routinely addressed already in practice without performing an ABI measurement? Just as no one needs pulmonary function tests to instruct asymptomatic smokers to stop, it would appear that physicians can safely and inexpensively take a history and implement, with a high degree of confidence, already established elements of evidence-based medicine without an ABI measurement. References 1. Belch JJFTopol EJAgnelli G et al. Critical issues in peripheral arterial disease detection and management: a call to action. Arch Intern Med. 2003;163884- 892PubMedGoogle ScholarCrossref
Archives of Internal Medicine – American Medical Association
Published: Dec 8, 2003
Keywords: cost effectiveness,evidence-based medicine
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