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Peripheral Arterial Disease Detection, Awareness, and Treatment in Primary Care
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 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]
In the citing paper
“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]
In the citing paper
“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 citing paper
“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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“‡ Other reasons include equipment malfunction (5), inability to perform ABI testing owing to patient factors (5), or missing data (5).”
BackgroundTreating patients with peripheral arterial disease and claudication
Treat‐Jacobson, D., & Walsh, M. E. (2003) · Journal of Vascular Nursing · doi:10.1067/mvn.2003.2 · Cited by 22
Bray, J. H. (2016) · American Psychological Association eBooks · doi:10.1037/14772-026 · Cited by 9
Burden of Peripheral Artery Disease on Mortality and Incident Cardiovascular Events
Unkart, J., Allison, M., Araneta, M. R. G., Ix, J. H., Matsushita, K., & Criqui, M. H. (2020) · American Journal of Epidemiology · doi:10.1093/aje/kwaa051 · Cited by 28
Statin use improves limb salvage after intervention for peripheral arterial disease
Parmar, G. M., Novak, Z., Spangler, E. L., Patterson, M. A., Passman, M. A., Beck, A. W., & Pearce, B. J. (2019) · Journal of Vascular Surgery · doi:10.1016/j.jvs.2018.07.089 · Cited by 28
Doshi, R., Changal, K., Gupta, R., Shah, J., Patel, K., Desai, R., Meraj, P., Syed, M., & Sheikh, A. (2018) · American Journal of Cardiology · doi:10.1016/j.amjcard.2018.08.018 · Cited by 24
McCarthy, C. P., Ibrahim, N. E., van Kimmenade, R. R. J., Gaggin, H. K., Simon, M. L., Gandhi, P. U., Kelly, N., Motiwala, S. R., Mukai, R., Magaret, C. A., et al. (2018) · Clinical Cardiology · doi:10.1002/clc.22939 · Cited by 29
Kim, B., Ko, Y.-G., Hong, S.-J., Ahn, C., Kim, J.-S., Kim, B.-K., Choi, D., Jang, Y., Hong, M., Lee, S. H., et al. (2018) · International Journal of Cardiology · doi:10.1016/j.ijcard.2017.11.065 · Cited by 24
Rehabilitation Therapy in Peripheral Arterial Disease.
Aggarwal, S., Moore, R., Arena, R., Marra, B., McBride, A., Lamb, B., Martin, B., & Stone, J. (2016) · Canadian Journal of Cardiology · doi:10.1016/j.cjca.2016.07.509 · Cited by 24
Paquissi, F. C., Cuvinje, A. B. P., & Cuvinje, A. B. (2016) · Scientifica · doi:10.1155/2016/2520973 · Cited by 19
“Themain risk factors are advanced age (>65 years), smoking, diabetes, hypertension, and chronic kidney disease [3, 15, 16].”
BackgroundIn-Hospital Outcomes of Atherectomy During Endovascular Lower Extremity Revascularization.
Panaich, S. S., Arora, S., Patel, N., Patel, N. J., Patel, S. V., Savani, C., Singh, V., Jhamnani, S., Sonani, R., Lahewala, S., et al. (2016) · American Journal of Cardiology · doi:10.1016/j.amjcard.2015.11.025 · Cited by 24
Hioki, H., Miyashita, Y., Miura, T., Ebisawa, S., Motoki, H., Izawa, A., Tomita, T., Koyama, J., & Ikeda, U. (2014) · Journal of Endovascular Therapy · doi:10.1583/14-4734mr.1 · Cited by 24
Peripheral artery disease, biomarkers, and darapladib
Berger, J. S., Ballantyne, C. M., Davidson, M. H., Johnson, J. L., Tarka, E. A., Lawrence, D., Trivedi, T., Zalewski, A. A., & Mohler, E. R. (2011) · American Heart Journal · doi:10.1016/j.ahj.2011.01.017 · Cited by 25
Osteoprotegerin is higher in peripheral arterial disease regardless of glycaemic status.
O'Sullivan, E. P., Ashley, D. T., Davenport, C., Kelly, J., Devlin, N., Crowley, R., Leahy, A., Kelly, C., Agha, A., Thompson, C., et al. (2010) · Thrombosis Research · doi:10.1016/j.thromres.2010.09.003 · Cited by 24
Escore para rastrear idosos (> 75 anos) de alto risco para doença arterial periférica
Makdisse, M. R. P., Ramos, L. R., Moreira, F. R., de Oliveira, A. A. M., Berwanger, O. B., Moscardi, A. A. V. D. S., Junqueira, V. B. C., Rodrigues, E. D. O., & Carvalho, A. C. (2007) · Arquivos Brasileiros de Cardiologia · doi:10.1590/s0066-782x2007000600002 · Cited by 22
Metadata
- 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
- 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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