Watch BP Office ABI Presenter Willem Verberk Date

Microlife Watch. BP Office ABI 2 © 2008 All Rights Reserved. No copy and

Watch. BP Office ABI : vascular screening device • Ankle Brachial Index (ABI) • Inter Arm Difference (IAD) • Atrial Fibrilation screening (Afib) 3 © 2008 All Rights Reserved. No copy and distribution without permission.

Watch. BP Office ABI Display 4 © 2008 All Rights Reserved. No copy and

Cuffs provided with Watch. BP ABI 5 © 2008 All Rights Reserved. No copy

ABI measurement ABI= 148/136 6 © 2008 All Rights Reserved. No copy and distribution

Ankle Brachial Index (ABI) ABI = ABI value 7 BPankle BParm Interpretation above 1. 3 Abnormal Vessel hardening from PVD 1. 0 - 1. 3 Normal range 0. 9 - 1. 0 Acceptable 0. 8 - 0. 9 Some arterial disease 0. 5 - 0. 8 Moderate arterial disease under 0. 5 Severe arterial disease © 2008 All Rights Reserved. No copy and distribution without permission.

Validation Procedure: Observers 8 • Two observers (A and B), assessed agreement in measuring SBP at the level of the brachial artery, the dorsalis pedis and the posterior tibial artery using a doppler device (5 -10 MHz) • All measurements of each individual participant were performed by the same observer (A or B, according to their availability). © 2008 All Rights Reserved. No copy and distribution without permission.

Validation procedure A NUMBER OF SEQUENTIAL MEASUREMENTS STEPS O FAMILIARIZATION PHASE Watch. BP Office random arm – leg simultaneous recording 9 A ARM SELECTION 1 Watch. BP Office Both arms simultaneous recordings* © 2008 All Rights Reserved. No copy and distribution without permission. 1 ABI 1 BP reading 3 BP readings

Arm selection IF IAD (consistently) >12 mm. Hg (Circulation 2006, ACC/AHA PDA guidelines) arm with higher BP is selected. Otherwise the right arm 10 © 2008 All Rights Reserved. No copy and distribution without permission.

Validation procedure B NUMBER OF SEQUENTIAL MEASUREMENTS STEPS 11 B Randomized order ( 1 vs 2) ABI MEASUREMENT 1 Doppler 2 Watch. BP Office Simultaneously R leg – R arm* Simultaneously L leg – R arm* R brachial artery L posterior tibial artery L dorsalis pedis artery R posterior tibial artery R dorsalis pedis artery © 2008 All Rights Reserved. No copy and distribution without permission. 2 legs ABI x 1 1 SBP reading 1 SBP reading 2 Legs ABI X 3 1 BP readings x 3

Doppler measurements 12 © 2008 All Rights Reserved. No copy and distribution without permission.

Artery compared 13 © 2008 All Rights Reserved. No copy and distribution without permission.

Watch. BP Office ABI Ankle Cuff Posterior tibial artery 14 © 2008 All Rights

Population q 93 patients o. Age 62. 5± 11. 1 years o. Men 62% o. Hypertension 83% o. Diabetes 45% o. Dyslipidemia 72% o. Smoking 15% ocardiovascular disease 23% 15 © 2008 All Rights Reserved. No copy and distribution without permission.

Results I Watch. BP vs. Doppler • 1 st measurement 1. 08± 0. 17 vs. 1. 11± 0. 17 • Difference of Doppler vs. Watch. BP • • Correlation Doppler and Watch. BP • • 16 0. 03 ± 0. 11 (1 st measurement) 0. 02 ± 0. 10 (average of 2 readings) 0. 02± 0. 09 (average of 3 readings; p<0. 01 for all). 0. 80 (1 st measurement ) 0. 84 (average of 2 readings) 0. 86 (average of 3 readings; P < 0. 001 for all) 95% Agreement diagnosing PAD (Doppler ABI <0. 9) © 2008 All Rights Reserved. No copy and distribution without permission.

Results II Watch. BP vs. Doppler 17 • Watch. BP failed to measure ABI (5 sequential errors) in 3 legs. All with Doppler ABI <0. 9. • Erroneous Watch. BP readings more frequent in patients with PAD (35. 2%) than without (5. 7%) respectively, p<0. 001). • The average time 3. 8± 0. 3 vs. 8. 8± 2. 2 min (p<0. 001). © 2008 All Rights Reserved. No copy and distribution without permission.

Conclusion Validation study Automated ABI determination using Microlife Watch. BP Office ABI is a quick, easy and reliable test for PAD detection Abstract ESH Oslo 2010 18 © 2008 All Rights Reserved. No copy and distribution without permission.

Doppler vs. Watch. BP Office 19 Difficult (education / skills required) easy Time consuming Fast Calculation needed Ratio is provided Not simultaneous Simultaneous Auscultatory Oscillometric © 2008 All Rights Reserved. No copy and distribution without permission.