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Cited by 2,835Peripheral Artery Disease ManagementDiabetic Foot Ulcer Assessment and ManagementVascular Procedures and Complications

Peripheral Arterial Disease Detection, Awareness, and Treatment in Primary Care

Hirsch, Alan T.·2001·JAMA
DOI 10.1001/jama.286.11.1317
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Abstract

Context Peripheral arterial disease (PAD) is a manifestation of systemic atherosclerosis that is common and is associated with an increased risk of death and ischemic events, yet may be underdiagnosed in primary care practice. Objective To assess the feasibility of detecting PAD in primary care clinics, patient and physician awareness of PAD, and intensity of risk factor treatment and use of antiplatelet therapies in primary care clinics. Design and setting The PAD Awareness, Risk, and Treatment: New Resources for Survival (PARTNERS) program, a multicenter, cross-sectional study conducted at 27 sites in 25 cities and 350 primary care practices throughout the United States in June-October 1999. Patients A total of 6979 patients aged 70 years or older or aged 50 through 69 years with history of cigarette smoking or diabetes were evaluated by history and by measurement of the ankle-brachial index (ABI). PAD was considered present if the ABI was 0.90 or less, if it was documented in the medical record, or if there was a history of limb revascularization. Cardiovascular disease (CVD) was defined as a history of atherosclerotic coronary, cerebral, or abdominal aortic aneurysmal disease. Main outcome measures Frequency of detection of PAD; physician and patient awareness of PAD diagnosis; treatment intensity in PAD patients compared with treatment of other forms of CVD and with patients without clinical evidence of atherosclerosis. Results PAD was detected in 1865 patients (29%); 82…

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  • In the PARTNERS program, 30% of people aged 50-69 years with a history of cigarette smoking or diabetes, or aged ≥70 years regardless of risk factors, had PAD.

    “In the PAD Awareness, Risk, and Treatment: New Resources for Survival (PARTNERS) program, 30% of people aged 50-69 years with a history of cigarette smoking or diabetes, or aged $70 years regardless of risk factors, had PAD (233).”

    From 10. Cardiovascular Disease and Risk Management: Standards of Care in Diabetes—2025 (2025) · cites this paper as [233]

  • Classical symptoms of claudication are uncommon, and almost half of people with newly diagnosed PAD were asymptomatic.

    “Notably, classical symptoms of claudication are uncommon, and almost half of people with newly diagnosed PAD were asymptomatic (233).”

    From 10. Cardiovascular Disease and Risk Management: Standards of Care in Diabetes—2025 (2025) · cites this paper as [233]

  • Classical symptoms of claudication are uncommon, and almost half of people with newly diagnosed PAD were asymptomatic.

    “Notably, classical symptoms of claudication are uncommon, and almost half of people with newly diagnosed PAD were asymptomatic (223).”

    From 10. Cardiovascular Disease and Risk Management: Standards of Care in Diabetes—2026 (2026) · cites this paper as [223]

  • In the PARTNERS program, 30% of people aged 50-69 years with a history of cigarette smoking or diabetes, or aged ≥70 years regardless of risk factors, had PAD.

    “In the PAD Awareness, Risk, and Treatment: New Resources for Survival (PARTNERS) program, 30% of people aged 50–69 years with a history of cigarette smoking or diabetes, or aged ≥70 years regardless of risk factors, had PAD (223).”

    From 10. Cardiovascular Disease and Risk Management: Standards of Care in Diabetes—2026 (2026) · cites this paper as [223]

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Authors
Hirsch, A. T.
Affiliations
University of Minnesota (US)
Corresponding author
Hirsch, Alan T.
Venue
JAMA
Publisher
American Medical Association (AMA)
Published
2001-09-19
Volume
286
Issue
11
Pages
1317
ISSN
  • 0002-9955 (ISSN-L)
  • 0098-7484
DOI
10.1001/jama.286.11.1317
OpenAlex
W2140136269
Cited by
2,835
References
0
Citations by year
2026: 59 · 2025: 77 · 2024: 89 · 2023: 102 · 2022: 113 · 2021: 127 · 2020: 100 · 2019: 105 · 2018: 147 · 2017: 105 · 2016: 135 · 2015: 122 · 2014: 160 · 2013: 145 · 2012: 166
FWCI
62.22
Type
journal article
Language
en
Open access
closed
Locations
  • JAMA (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • National Institutes of Health (5k07hl003435-05)
  • National Heart, Lung, and Blood Institute (1-K07-HL03435-01)
Topics
  • Health Sciences › Medicine › Surgery › Peripheral Artery Disease Management
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetic Foot Ulcer Assessment and Management
  • Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Vascular Procedures and Complications
Keywords
peripheral arterial disease, ankle-brachial index, underdiagnosis, patient awareness, physician awareness, cardiovascular disease, atherosclerosis, antiplatelet therapy, smoking cessation, diabetes mellitus, intermittent claudication, primary care, older adults, limb revascularization, cardiovascular risk stratification, diabetes self-management education
MeSH terms
Aged, Arteriosclerosis, Cardiovascular Diseases, Cross-Sectional Studies, Family Practice, Female, Humans, Intermittent Claudication, Health Knowledge, Attitudes, Practice, Male, Middle Aged, Platelet Aggregation Inhibitors, Risk Factors, Ultrasonography, Doppler

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