Sj. Savader et al., The legs for life screening for peripheral vascular disease: Compliance with physician recommendations in moderate- and high-risk assessed patients, J VAS INT R, 12(1), 2001, pp. 33-37
PURPOSE: To determine compliance within a community with recommendations ma
de by physicians during the 1999 Legs for Life National Screening for Perip
heral Vascular Disease (PVD) and Leg Pain.
MATERIALS AND METHODS: Patients were initially screened for PVD by completi
on of the Legs for Life risk factor questionnaire and determination of bila
teral ankle/brachial indexes (ABIs). Each patient subsequently met with an
interventional radiologist or vascular surgeon. Patients with normal ABIs (
>1.0 bilaterally) or mildly abnormal ABI(s) (<1.0 but >0.90) were classifie
d at no and low risk for PVD, respectively; patients with ABI(s) of 0.70-0.
89 were classified at moderate risk for PVD; and patients with ABI(s) <0.69
were classified at high risk for PVD. Risk factors for PVD were assessed b
y the consulting physician and discussed with all patients. Recommendations
were made for additional evaluation and/or follow-up care, if necessary. S
even months after screening, patients who were assessed at moderate and hig
h risk for PVD were contacted by telephone to determine if they had pursued
additional care or testing.
RESULTS: A total of 205 patients were screened for PVD, 48 (23%) of whom we
re determined to be at moderate to high risk. Forty-four (92%) patients wer
e available for follow-up. At 7 months after screening, 31 (70%) patients h
ad received no further medical advice or treatment. Thirteen (30%) of these
patients had completed a follow-up appointment, but only three with a phys
ician specializing in peripheral vascular disease. None of the patients had
clinical follow-up with an interventional radiologist. Five (11%) patients
had undergone noninvasive Doppler evaluation and one (2%) had undergone di
agnostic arteriography. No patient had undergone any form of percutaneous o
r surgical intervention.
CONCLUSION: Patient compliance with physician recommendations after outpati
ent screening for PVD is low. The Legs for Life screening program could be
considered successful in that it provides far patient education and the ide
ntification of moderate to high-risk patients. Physicians participating in
this program may have to modify their approach to patient screening and fol
low-up if a concomitant goal is to deliver specialty care.