Authors (including presenting author) :
Li TCJ (1), Pang KSK (1), Chau KYH (1), Ngai YCC (1), Wong N (2), Yung CK (2), Mak KM (2), Tsui KN (2)
Affiliation :
(1) Kowloon East Cluster Podiatry Department (2) Haven of Hope Hospital Medical Ward 2A
Introduction :
Peripheral vascular disease (PVD) is primarily caused by atherosclerosis and can lead to significant morbidity e.g. ischaemic foot ulcers, toe gangrene, and a high risk of amputation. The prevalence of PVD has been globally estimated, but local studies are limited. PVD is common but diagnosing it can be challenging. In the local ward, there are sporadic cases of acute or chronic lower limb ischemia with foot ulceration, gangrene occurring in a seasonal pattern, which caused an extended length of stay and medical complications. To address this, the podiatrist will conduct a thorough vascular assessment using Ankle-Brachial & Toe- Brachial Pressure Index test (ABPI & TBPI) for effective screening. However, routine PVD screening is not currently established in inpatient settings. As such, establishing a routine PVD screening to manage and address lower limb and foot problems for early intervention is crucial for improving prognosis and avoiding devastating foot complications.
Objectives :
The aim of this study is to identify the local prevalence of PVD for at risk patients in Haven of Hope Hospital (HHH) and to investigate the association of PVD with cardiovascular risk factors.
Methodology :
This study was conducted in collaboration with the HHH Geriatric team in 2A ward. There were a total number of 79 male patients were included for this study, with the mean age of 88, ranged from 68 to 100 years of age. Of the 79 patients, 58.2% had a history of diabetes and 56.9% had a history of hyperlipidemia. Initial assessment upon admission were screened by nurses and followed by the HHH podiatry team to perform a podiatric vascular assessment. ABPI value classified as follow: 0.7 – 0.89 mild PVD, 0.4 – 0.69 moderate PVD, < 0.4 severe PVD. TBPI value classified as follow: <0.7 mild to moderate, <0.35 severe PVD. The data were analyzed with values reported in both numerical figures and total percentage score. Logistic regression was used to investigate the association between PVD and various cardiovascular risk factors. Pearson’s correlation coefficient was also used to determine whether there is a correlation between PVD and ischaemic foot features.
Result & Outcome :
The local prevalence of PVD is high as indicated in this study, therefore the clinical gap is identified and the urge of podiatric vascular assessment is needed to improve the patient's outcome. There were 40 patients diagnosed with PVD, accounting for 50.6% of the total, with 12.5% classified as severe PVD. Patients with history of smoking have the highest odds ratios (OR = 1.86, 95% CI = 0.5-6.93) and relative risks (RR = 1.31, 95% CI = 0.79-2.18). More importantly, other risk aggravating factor such as hyperlipidaemia, cardiovascular disease and renal impairment all presenting with an OR and RR value > 1, which indicated the probability of having PVD with those risk factors are positively associated with an increased risk. Moreover, the result show that certain ischaemic foot features such as abnormal pedal pulse, capillary refill time are moderately correlated to PVD, whereas foot temp and toe cyanosis have a considerably weaker correlation. Such measures could help identify those who are at risk to facilitate early detection of PVD for timely intervention and minimize the incidence rate of acute limb ischaemia during hospitalisation.
