Prospective assessment of the diagnostic accuracy of multi-site photoplethysmography pulse measurements for diagnosis of peripheral artery disease in primary care

Gerard Stansby, Andrew J. Sims, Lesley Wilson, Thomas A. W. Beale, James Wightman, Ina Guri, Scott Wilkes, Shona Haining, John Allen, NOTEPAD Study Team

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    Peripheral arterial disease (PAD) is associated with cerebral and coronary artery disease. Symptomatic PAD affects about 5% of people over 55 years; many more have asymptomatic PAD. Early detection enables modification of arterial disease risk factors. Diagnostically, assessment of symptoms or signs can be unreliable; ankle brachial pressure index (ABPI) testing is time-consuming and few healthcare professionals are properly trained. This study assessed the diagnostic accuracy of multi-site photoplethysmography (MPPG), an alternative non-invasive test for PAD, in primary care. PAD patients identified from general practice registers were age- and sex-matched with controls. Participants were assessed using MPPG, ABPI and duplex ultrasound (DUS). Outcome measures were sensitivity and specificity of MPPG and ABPI (relative to DUS) and concordance. MPPG test results were available in 249 of 298 eligible participants from 16 practices between May 2015 and November 2016. DUS detected PAD in 101/249 (40.6%). MPPG sensitivity was 79.8% (95% confidence interval [CI] 69.9–87.6%), with specificity 71.9% (95% CI 63.7–79.2%). ABPI sensitivity was 80.2% (95% CI 70.8–87.6%), with specificity 88.6% (95% CI 82–93.5%). With comparable sensitivity to ABPI, MPPG is quick, automated and simpler to do than ABPI; it offers the potential for rapid and accessible PAD assessments in primary care.
    Original languageEnglish
    Pages (from-to)859-867
    Number of pages9
    Issue number9
    Early online date18 Aug 2022
    Publication statusPublished - Oct 2023

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    Funding Information: This report is independent research funded by the National Institute for Health and Care Research (NIHR), Invention for Innovation project grant ‘Innovative photoplethysmography technology for rapid non-invasive assessment of peripheral arterial disease in primary care’, II-C1-0412-20003.


    • diagnosis
    • duplex ultrasound
    • peripheral arterial disease
    • photoplethysmography


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