NATIONAL STUDY OF OBLITERATIVE ARTERIAL-DISEASE OF THE LOWER-LIMBS INVOLVING GENERAL-PRACTITIONERS IN FRANCE - ARTEMIO STUDY

A national survey was performed in France from May to June, 1993. The aim of this study was to evaluate general practitioners' attitudes and behaviors when diagnosing and managing patients with lower extremity arterial disease (LEAD). One thousand general practitioners, randomly drawn from an exhaustive list, were contacted to participate in a tele phone interview concerning the last patient with intermittent claudica tion seen in their practice. Four hundred seventy-six general practiti oners participated. Risk factors noted for these 476 patients with int ermittent claudication were in agreement with the literature: 86% were men aged 64 +/- 10 years (mean +/- SD) and 14% were women aged 73 +/- 8 years. Sixty-two percent had a pain-free walking distance of betwee n 100 and 500 meters at diagnosis. Forty-five percent were former smok ers and 37% currently smoked; 55% had hypertension, 14% diabetes, and 56% disturbances of lipid metabolism. A majority of them were hypercho lesterolemic. The diagnosis of the disease was based primarily on a cl inical assessment, confirmed for 33% by Doppler or echo Doppler. The m ean duration of diagnosis was 4.4 +/- 4.1 years. Management of the dis ease was mainly by prescription of vasodilators (91%), antiplatelet ag ents (59%), and anticoagulants (8%), Use of Doppler or echo Doppler wa s recommended once a year. Infection was observed in 27% of patients. Thirty-eight percent had had a cardiac incident (angina pectoris or my ocardial infarction) and 10% a cerebrovascular accident. They differed significantly from those with LEAD alone for the following parameters : age (68.5 +/- 9.2 vs, 63.2 +/- 10.3 years; p < 0.001); duration of L EAD (5.6 +/- 4.6 vs, 3.6 +/- 3.5 years; p < 0.001); hypertension (65% vs, 50%; p < 0.01); and current smoking (29% vs. 43%; p < 0.01). This survey confirmed the feasibility of telephone interviewing, on a large sample of general practitioners in France. The high level of associat ion with other cardiac incidents was, for these patients, a much highe r risk of mortality and morbidity than LEAD alone. It would be interes ting to validate the associations observed with a prospective study of comorbidity.