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

doi:10.1177/00033197221121614

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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Abstract

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 language	English
Pages (from-to)	859-867
Number of pages	9
Journal	Angiology
Volume	74
Issue number	9
Early online date	18 Aug 2022
DOIs	https://doi.org/10.1177/00033197221121614
Publication status	Published - Oct 2023

Bibliographical note

Copyright © and Moral Rights are retained by the author(s) and/ or other
copyright owners. A copy can be downloaded for personal non-commercial
research or study, without prior permission or charge. This item cannot be
reproduced or quoted extensively from without first obtaining permission in
writing from the copyright holder(s). The content must not be changed in any
way or sold commercially in any format or medium without the formal
permission of the copyright holders.

This document is the author’s post-print version, incorporating any revisions
agreed during the peer-review process. Some differences between the
published version and this version may remain and you are advised to consult
the published version if you wish to cite from it.

Funder

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.

Keywords

diagnosis
duplex ultrasound
peripheral arterial disease
photoplethysmography

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Stansby, G., Sims, A. J., Wilson, L., Beale, T. A. W., Wightman, J., Guri, I., Wilkes, S., Haining, S., Allen, J., & NOTEPAD Study Team (2023). Prospective assessment of the diagnostic accuracy of multi-site photoplethysmography pulse measurements for diagnosis of peripheral artery disease in primary care. Angiology, 74(9), 859-867. https://doi.org/10.1177/00033197221121614

Stansby, G, Sims, AJ, Wilson, L, Beale, TAW, Wightman, J, Guri, I, Wilkes, S, Haining, S, Allen, J & NOTEPAD Study Team 2023, 'Prospective assessment of the diagnostic accuracy of multi-site photoplethysmography pulse measurements for diagnosis of peripheral artery disease in primary care', Angiology, vol. 74, no. 9, pp. 859-867. https://doi.org/10.1177/00033197221121614

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abstract = "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.",

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N1 - Copyright © and Moral Rights are retained by the author(s) and/ or other copyright owners. A copy can be downloaded for personal non-commercial research or study, without prior permission or charge. This item cannot be reproduced or quoted extensively from without first obtaining permission in writing from the copyright holder(s). The content must not be changed in any way or sold commercially in any format or medium without the formal permission of the copyright holders. This document is the author’s post-print version, incorporating any revisions agreed during the peer-review process. Some differences between the published version and this version may remain and you are advised to consult the published version if you wish to cite from it.

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N2 - 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.

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

Abstract

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