Abstracts from The College of Podiatry Annual Conference 2017

s from The College of Podiatry Annual Conference 2017 Liverpool, United Kingdom. 16-18 November 2017 Published: 22 February 2018 O01 Intermittent claudication – how frequently is it misdiagnosed in the primary care sector? Anabelle Mizzi, Kevin Cassar, Catherine Bowen, Cynthia Formosa Faculty of Health Sciences, Podiatry Department, University of Malta, Msida, Malta; Faculty of Medicine and Surgery, Mater Dei Hospital, University of Malta, Msida, Malta; Faculty of Health Sciences, University of Southampton, Southampton, UK Journal of Foot and Ankle Research 2018, 11(Suppl 1):O01 Background: The commonest symptom of peripheral arterial disease (PAD) is intermittent claudication (IC). This is associated with an increased risk of myocardial infarction, stroke and cardiovascular mortality. Often patients consult general practitioners (GPs) within primary healthcare sectors. These patients are often referred to the vascular surgeon for specialist assessment and possible revascularisation. Misdiagnosis of IC at the primary visit may lead to inappropriate referral and delayed treatment. The aim of this study was to determine what proportion of patients referred for intermittent claudication by GPs in Malta for specialist vascular assessment actually have vascular disease. Methods: A cross-sectional observational study was conducted, where all patients referred to a vascular clinic in a local hospital between July 2016 and May 2017, due to IC were invited to participate. Individuals who gave informed consent to participate were assessed for PAD by hemodynamic analysis including Doppler waveforms, ankle-brachial pressure index (ABPI), absolute toe pressures and toebrachial pressure index (TBPI). A full medical history including medications taken to assess current risk factor control and associated participant demographics were noted. Results: A total of 107 participants were recruited. Fifty-five participants (51.4%) had a confirmed diagnosis of PAD with abnormal Doppler waveforms, sub-optimal ABPI and /or absolute toe pressures and TBPIs. Forty-nine participants (45.8%) had been misdiagnosed, since they presented with triphasic waveforms and normal ankle and toe pressures, indicating no significant vascular impairment. Two participants had possible mixed aetiology of symptoms with marginally abnormal hemodynamics and also spinal stenosis. Ten participants (9.3%) were found to have a systolic blood pressure >160mmHg and were referred to the GP since they were not taking antihypertensive therapy. Eighteen (11.5%) participants were referred back to their GP for risk factor management such as antiplatelet and statins after diagnosis of PAD was confirmed. Discussion: Results demonstrate that the diagnosis of PAD cannot be based solely on clinical symptoms of IC but requires further hemodynamic analysis prior to referral to the vascular surgeon. Differential diagnosis from other conditions which may mimic IC, such as spinal stenosis, is necessary to improve the efficacy of referrals. Inappropriate referrals lead to unnecessary clinical load on a relatively small department resulting in delayed routine new appointments with the vascular surgeon. Doppler waveform analysis, ABPI and TBPIs are essential tests performed by podiatrists as part of the investigation of symptoms of IC. Use of such haemodynamic testing prior to referral to vascular © The Author(s). 2018 Open Access This artic International License (http://creativecommons reproduction in any medium, provided you g the Creative Commons license, and indicate if (http://creativecommons.org/publicdomain/ze surgery ensures that patients are only referred where haemodynamic abnormalities are detected as well as identifies those patients with more severe disease, ensuring appropriate prioritisation of cases. Furthermore, immediate referral for appropriate risk factor control in patients with confirmed PAD can be implemented and can lead to a reduction in major cardiovascular events. Additionally, effective referral pathways can also be implemented in those patients who present with symptoms similar to IC due to alternative diagnosis. In patients with IC, haemodynamic analysis at primary care level is recommended in order to ensure appropriate and efficient patient referral and decrease the risk of morbidity. O02 Ethical practice the difference between knowing and doing