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USPSTF 2018: insufficient evidence to recommend PAD screening (I statement)
Clinical Question
Should primary care clinicians screen adults for peripheral artery disease with the ankle-brachial index?
Bottom line
In this updated 2018 review, the US Preventive Services Task Force (USPSTF) concludes there is insufficient evidence to recommend screening for peripheral artery disease (PAD) using the ankle-brachial index (ABI) in asymptomatic adults (I statement). These recommendations are unchanged from the 2013 USPSTF recommendations. 2c
Reference
Study design: Practice guideline
Funding: Government
Setting: Population-based
Synopsis
The USPSTF found no randomized trials of the individual effect of PAD screening in asymptomatic adults. Two studies comparing aspirin therapy and 2 studies comparing exercise therapy addressed the treatment of asymptomatic adults with low ABI or PAD. None of these studies reported any significant difference in cardiovascular events, mortality, development of PAD symptoms, PAD revascularization procedures, amputations, or improved quality of life. No direct evidence of harm was found, but potential harms include false positive test results and resultant anxiety, exposure to gadolinium or contrast dye, disease labeling, and unnecessary costs. The American College of Cardiology. the American Heart Association, and the Society for Vascular Surgery recommend screening for PAD in asymptomatic adults at increased risk. The American Academy of Family Physicians concluded that evidence is insufficient to recommend for or against screening for PAD in asymptomatic adults.
Reviewer
David C. Slawson, MD
Professor and Vice Chair of Family Medicine for Education and Scholarship
Atrium Health
Professor of Family Medicine, UNC Chapel Hill
Charlotte, NC
Comments
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It seems that "anxiety" is something to be avoided at ALL COSTS. As far as I know, there is no mortality epidemic related to "anxiety", occurring at this point in time.