Dr Sally Inglis

Stewart, S., Inglis, S. & Hawkes, A. 2006, A Practical Guide to Specialist Nurse Management., Blackwell Publishing, BMJ Books, Massachusetts.

Disler, R.T., Inglis, S. & Davidson, P.M. 2013, 'Non-pharmacological management interventions for COPD: an overview of Cochrane systematic reviews (Protocol)', The Cochrane Database of Systematic Reviews, vol. 2.

Ferguson, C., Inglis, S., Newton, P.J., Middleton, S., Macdonald, P. & Davidson, P.M. 2013, 'Atrial fibrillation and thromboprophylaxis in heart failure: The need for patient centered approaches to address adherence', Vascular Health and Risk Management, vol. 9, pp. 3-11.
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Atrial fibrillation is a common arrhythmia in heart failure and a risk factor for stroke. Risk assessment tools can assist clinicians with decision-making in the allocation of thromboprophylaxis. This review provides an overview of current validated risk assessment tools for AF and emphasises the importance of addressing both tailoring individual risk for stroke and weighing the benefits of treatment. Further, this review provides details of innovative and patient centered methods for ensuring optimal adherence to prescribed therapy. Prior to initiating oral anticoagulant therapy a comprehensive risk assessment should include evaluation of associated cardio-geriatric conditions, potential for adherence to prescribed therapy, frailty, functional and cognitive ability.

Davidson, P.M., Mitchell, J., DiGiacomo, M., Inglis, S., Newton, P.J., Harman, J. & Daly, J. 2012, 'Cardiovascular disease in women: implications for improving health outcomes', Collegian, vol. 19, no. 1, pp. 5-13.
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This literature review collated data on women and cardiovascular disease in Australia and globally to inform public health campaigns and health care interventions. If found that women with acute coronary syndromes show consistently poorer outcomes than men, independent of comorbidity and management, despite less anatomical obstruction of coronary arteries and relatively preserved left ventricular function. Higher mortality and complication rates are best documented amongst younger women and those with STsegment-elevation myocardial infarction. Sex differences in atherogenesis and cardiovascular adaptation have been hypothesised, but not proven. Atrial fibrillation carries a relatively greater risk of stroke in women than in men, and anticoagulation therapy is associated with higher risk of bleeding complications. The degree of risk conferred by single cardiovascular risk factors and combinations of risk factors may differ between the sexes, and marked postmenopausal changes are seen in some risk factors. Sociocultural factors, delays in seeking care and differences in self-management behaviours may contribute to poorer outcomes in women. Differences in clinical management for women, including higher rates of misdiagnosis and less aggressive treatment, have been reported, but there is a lack of evidence to determine their effects on outcomes, especially in angina. Although enrolment of women in randomised clinical trials has increased since the 1970s, women remain underrepresented in cardiovascular clinical trials. Improvement in the prevention and management of CVD in women will require a deeper understanding of womenÔ++s needs by the community, health care professionals, researchers and government.

Disler, R.T., Inglis, S., Currow, D.C. & Davidson, P.M. 2012, 'Palliative and supportive care in COPD: research priorities to decrease suffering.', Journal of Pulmonary and Respiratory Medicine, vol. 1, no. 6, pp. 1-3.
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Chronic obstructive pulmonary disease (COPD) affects 80 million people worldwide, is the fourth most prevalent cause of death globally and accounts for 3.5% of total years lost due to disability. Despite the similarities with malignant disease, many individuals suffer unnecessarily and continue to have limited access to palliative and endof-life care.

Disler, R.T., Green, A.R., Luckett, T., Newton, P.J., Inglis, S., Currow, D.C. & Davidson, P.M. 2012, 'Unmet needs in chronic obstructive pulmonary disease: a metasynthesis protocol', International Journal of Research in Nursing, vol. 3, no. 1, pp. 15-20.
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Abstract: Problem statement: Chronic obstructive pulmonary disease is a chronic progressive illness. Despite the high burden experienced by individuals in the advanced stages of illness, individuals with advanced COPD continue to have unmet needs and limited access to palliative care. This Metasynthesis seeks to describe: the barriers and facilitators care access and provision; the unmet needs of individuals with advanced COPD, their families and carers; and the experiences of health professionals. Data sources: Medline, PsychINFO, AMED, CINAHL and Sociological Abstracts were searched for articles published between 1990 and December 31st 2011. Medical Subject Headings (MeSH) and key words will be used to guide the search. The strategy will be reviewed by the CareSearch palliative knowledge network and a health informatics expert. Approach: Metasyntheses are increasingly used to gain new insights and understandings of complex research questions through the amalgamation of data from individual qualitative studies. The principles of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and thematic synthesis will be used to achieve consistent reporting and transparency of methods. Results: Inclusion of studies, quality assessment and allocation of free codes into EPPI-Reviewer 4 software will be carried out by two independent investigators. Auditing of random cases will be undertaken and disagreements resolved through group discussion of an expert panel. Descriptive and analytical themes will be developed through thematic synthesis and expert panel discussion. Conclusion: Qualitative data provide useful information in understanding the individual's unique experience. Combining discrete qualitative studies provides an important opportunity to provide a voice to patients, their families and professional careers in managing advanced COPD.

Inglis, S., Du, H., Newton, P.J., DiGiacomo, M., Omari, A. & Davidson, P.M. 2012, 'Disease management interventions for improving self-management in lower-limb peripheral arterial disease (Protocol)', The Cochrane Database of Systematic Reviews, vol. 3, pp. 1-11.
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Evidence supports the use of chronic disease management interventions to improve self-management in chronic diseases other than PAD, however it is unclear what benefits these interventions offer for people with PAD. To our knowledge, there are no other systematic reviews of the evidence for chronic disease management interventions to improve self-management for lower-limb PAD. The objective of this review is to systematically review, synthesise and quantify the effects of non-pharmacological and non-surgical chronic disease management interventions targeting self-management for people with lower-limb PAD.

Inglis, S., Lewsey, J., Chandler, D., Byrne, D., Lowe, G.D. & MacIntyre, K. 2012, 'Sex-specific time trends in first admission to hospital for peripheral artery disease in Scotland 1991- 2007', British Journal of Surgery, vol. 99, no. 5, pp. 680-687.
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Background: This study examined trends for all first hospital admissions for peripheral artery disease (PAD) in Scotland from 1991 to 2007 using the Scottish Morbidity Record. Methods: First admissions to hospital for PAD were defined as an admission to hospital (inpatient and day-case) with a principal diagnosis of PAD, with no previous admission to hospital (principal or secondary diagnosis) for PAD in the previous 10 years. Results: From 1991 to 2007, 41 593 individuals were admitted to hospital in Scotland for the first time for PAD. Some 23 016 (55À3 per cent) were men (mean(s.d.) age 65À7(11À7) years) and 18 577 were women (aged 70À4(12À8) years). For both sexes the population rate of first admissions to hospital for PAD declined over the study interval: from 66À7 per 100 000 in 1991-1993 to 39À7 per 100 000 in 2006-2007 among men, and from 43À5 to 29À1 per 100 000 respectively among women. After adjustment, the decline was estimated to be 42 per cent in men and 27 per cent in women (rate ratio for 2007 versus 1991: 0À58 (95 per cent confidence interval 0À55 to 0À62) in men and 0À73 (0À68 to 0À78) in women). The intervention rate fell from 80À8 to 74À4 per cent in men and from 77À9 to 64À9 per cent in women. The proportion of hospital admissions as an emergency or transfer increased, from 23À9 to 40À7 per cent among men and from 30À0 to 49À5 per cent among women. Conclusion: First hospital admission for PAD in Scotland declined steadily and substantially between 1991 and 2007, with an increase in the proportion that was unplanned.

Inglis, S., Stewart, S., Papachan, A., Vaghela, V., Libhaber, C., Veriava, Y. & Sliwa, K. 2011, 'Anaemia and renal function in heart failure due to idiopathic dilated cardiomyopathy', European Journal of Heart Failure, vol. 9.
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To investigate the frequency of anaemia and renal dysfunction and the relationship between the two within a cohort of 163 newly diagnosed Black African idiopathic cardiomyopathy patients prior to commencing HF treatments and compare those findings to those of western HF cohorts

Inglis, S., Clark, R., McAlister, F., Stewart, S. & Cleland, J.G. 2011, 'Telemedicine and remote management of heart failure. Letter to the Editor.', The Lancet, vol. 378.

Inglis, S., clark, R.A. & Cleland, J.G. 2011, 'Telemonitoring in patients with heart failure. Letter to the Editor', New England Journal Of Medicine, vol. 364.

Inglis, S., clark, R.A., McAlister, F., Stewart, S. & Cleland, J.G. 2011, 'Which components of heart failure programmes are effective? A systematic review and meta-analysis of the outcomes of structured telephone support or telemonitoring as the primary component of chronic heart failure management in 8,323 patients (Abridg', European Journal of Heart Failure, vol. 13.
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Chronic heart failure (CHF) specialized disease management programmes improve survival and quality of life, reduce rehospitalization, and increase the implementation of evidence-based practice [1,2] However, most of the successful CHF disease management programmes have been built around close clinical follow-up. The need for intense face-to-face follow-up strategies limits the number of patients who can participate in these programmes.

Inglis, S., McMurray, J.J., Bohm, V., Schaufelberger, M., van Veldhuisen, D., Lindberg, M., Dunselman, P., Hjalmarson, A., Kjekshus, J., Waagstein, F., Wedel, H. & Wikstrand, J. 2010, 'Intermittent claudication as a predictor of outcome in patients with ischemic systolic heart failure: analysis of the Controlled Rosuvastatin Multinational Trial in Heart Failure trial (CORONA).', European Journal of Heart Failure, vol. 12, no. 7, pp. 698-705.
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To examine the relationship between baseline intermittent claudication and outcomes in patients enrolled in the Controlled Rosuvastatin Multinational Trial in Heart Failure trial (CORONA). Intermittent claudication is an independent predictor of worse outcome in coronary heart disease, but its prognostic importance in heart failure (HF) is unknown. Patients aged .60 years with NYHA class II-IV, low ejection fraction HF of ischaemic aetiology were enrolled in CORONA. Rosuvastatin did not reduce the primary outcome or all-cause mortality.

Inglis, S. 2010, 'Structured telephone support or telemonitoring programmes for patients with chronic heart failure.', Journal of Evidence-Based Medicine, vol. 3.

Inglis, S., clark, R.A., Shakib, S., Wong, D., Molaee, P., Wilkinson, D. & Stewart, S. 2008, 'Hot summers and heart failure: seasonal variations in morbidity and mortality in Australian heart failure patients (1994-2005)', European Journal of Heart Failure, vol. 10, no. 6, pp. 540-549.
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Background: There are minimal reports of seasonal variations in chronic heart failure (CHF)-related morbidity and mortality beyond the northern hemisphere. Aims and methods: We examined potential seasonal variations with respect to morbidity and all-cause mortality over more than a decade in a cohort of 2961 patients with CHF from a tertiary referral hospital in South Australia subject to mild winters and hot summers. Results: Seasonal variation across all event-types was observed. CHF-related morbidity peaked in winter (July) and was lowest in summer (February): 70 (95% CI: 65 to 76) vs. 33 (95% CI: 30 to 37) admissions/1000 at risk (pb0.005). All-cause admissions (113 (95% CI: 107 to 120) vs. 73 (95% CI 68 to 79) admissions/1000 at risk, pb0.001) and concurrent respiratory disease (21% vs. 12%, pb0.001) were consistently higher in winter. 2010 patients died, mortality was highest in August relative to February: 23 (95% CI: 20 to 27) vs. 12 (95% CI: 10 to 15) deaths per 1000 at risk, pb0.001. Those aged 75 years or older were most at risk of seasonal variations in morbidity and mortality. Conclusion: Seasonal variations in CHF-related morbidity and mortality occur in the hot climate of South Australia, suggesting that relative (rather than absolute) changes in temperature drive this global phenomenon.

Inglis, S., Clark, R.A., Cleland, J.G., McAlister, F. & Stewart, S. 2008, 'Structured telephone support or telemonitoring programs for patients with chronic heart failure (Protocol)', The Cochrane Database of Systematic Reviews, vol. 3, pp. 1-12.
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Chronic heart failure (CHF) is a complex, debilitating syndrome which is the consequence of structural abnormality or cardiac dysfunction that impairs the ability of the ventricle to ?ll with, or eject blood. As a result typical symptoms such as dyspnoea and fatigue occur at rest or with physical effort. CHF often results from damage to the myocardium for which the aetiology differs according to the population studied. In high income nations CHF is often the end-product of underlying coronary heart disease. In low to medium income nations the syndrome is often the result of longstanding hypertension, cardiomyopathy or rheumatic heart disease (Sliwa 2005). This trend is changing, with the incidence and prevalence of cardiovascular disease increasing in low to medium income nations (Yusuf 2001). CHF exerts a signi?cant burden on healthcare systems, with the majority of its economic burden attributable to repeated and lengthy admissions to hospital (Stewart 2002). As the prevalence of CHF increases with the ageing of populations internationally, this situation will deteriorate unless new management strategies are developed (Cleland 2000).

clark, R.A., Inglis, S., McAlister, F., Cleland, J.G. & Stewart, S. 2007, 'Telemonitoring or structured telephone support programmes for patients with chronic heart failure: systematic review and meta-analysis', British Medical Journal, vol. 334, no. 942, pp. 1-9.
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Objective To determine whether remote monitoring (structured telephone support or telemonitoring) without regular clinic or home visits improves outcomes for patients with chronic heart failure. Data sources 15 electronic databases, hand searches of previous studies, and contact with authors and experts. Data extraction Two investigators independently screened the results. Review methods Published randomised controlled trials comparing remote monitoring programmes with usual care in patients with chronic heart failure managed within the community. Results 14 randomised controlled trials (4264 patients) of remote monitoring met the inclusion criteria: four evaluated telemonitoring, nine evaluated structured telephone support, and one evaluated both. Remote monitoring programmes reduced the rates of admission to hospital for chronic heart failure by 21% (95% confidence interval 11% to 31%) and all cause mortality by 20% (8% to 31%); of the six trials evaluating health related quality of life three reported significant benefits with remote monitoring, and of the four studies examining healthcare costs with structured telephone support three reported reduced cost and one no effect. Conclusion Programmes for chronic heart failure that include remote monitoring have a positive effect on clinical outcomes in community dwelling patients with chronic heart failure.

Inglis, S., Herbert, M.K., Davies, B.J., Coller, J.K., James, H.M., Horowitz, J.D., Morris, R.G., Milne, R.W., Somogyi, A.A. & Sallustio, B.C. 2007, 'Effect of CYP2D6 metabolizer status on the disposition of the (+) and (-) enantiomers of perhexiline in patients with myocardial ischaemia', Pharmacogenetics and Genomics, vol. 17, no. 5, pp. 305-312.
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Aims: This study investigated the effects of increasing doses of rac-perhexiline maleate and CYP2D6 phenotype and genotype on the pharmacokinetics of (+) and (-)-perhexiline. Methods: In a prospective study, steady-state plasma concentrations of (+) and (-)-perhexiline were quantified in 10 CYP2D6 genotyped patients following dosing with 100 mg/day rac-perhexiline maleate, and following a subsequent dosage increase to 150 or 200 mg/day. In a retrospective study, steady-state plasma concentrations of (+) and (-)-perhexiline were obtained from 111 CYP2D6 phenotyped patients receiving rac-perhexiline maleate. Aims: This study investigated the effects of increasing doses of rac-perhexiline maleate and CYP2D6 phenotype and genotype on the pharmacokinetics of (+) and (-)-perhexiline. Methods: In a prospective study, steady-state plasma concentrations of (+) and (-)-perhexiline were quantified in 10 CYP2D6 genotyped patients following dosing with 100 mg/day rac-perhexiline maleate, and following a subsequent dosage increase to 150 or 200 mg/day. In a retrospective study, steady-state plasma concentrations of (+) and (-)-perhexiline were obtained from 111 CYP2D6 phenotyped patients receiving rac-perhexiline maleate. Conclusions: Perhexiline's pharmacokinetics exhibit significant enantioselectivity in CYP2D6 extensive/intermediate and poor metabolizers, with both enantiomers displaying polymorphic and saturable metabolism via CYP2D6. Clinical use of rac-perhexiline may be improved by developing specific enantiomer target plasma concentration ranges.

Inglis, S., Pearson, S., Treen, S., Gallasch, T., Horowitz, J.D. & Stewart, S. 2006, 'Extending the horizon in chronic heart failure: effects of multidisciplinary, home-based intervention relative to usual care', Circulation, vol. 114, no. 23, pp. 2466-2473.
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Background+ The long-term impact of chronic heart failure management programs over the typical life span of affected individuals is unknown. Methods and Results+ The effects of a nurse-led, multidisciplinary, home-based intervention (HBI) in a typically elderly cohort of patients with chronic heart failure initially randomized to either HBI (n=149) or usual postdischarge care (UC) (n=148) after a short-term hospitalization were studied for up to 10 years of follow-up (minimum 7.5 years of follow-up). Study end points were all-cause mortality, event-free survival (event was defined as death or unplanned hospitalization), recurrent hospital stay, and cost per life-year gained. Median survival in the HBI cohort was almost twice that of UC (40 versus 22 months; P<0.001), with fewer deaths overall (HBI, 77% versus 89%; adjusted relative risk, 0.74; 95% CI, 0.53 to 0.80; P<0.001). HBI was associated with prolonged event-free survival (median, 7 versus 4 months; P<0.01). HBI patients had more unplanned readmissions (560 versus 550) but took 7 years to overtake UC; the rates of readmission (2.04¦3.23 versus 3.66¦7.62 admissions; P<0.05) and related hospital stay (14.8¦23.0 versus 28.4¦53.4 days per patient per year; P<0.05) were significantly lower in the HBI group. HBI was associated with 120 more life-years per 100 patients treated compared with UC (405 versus 285 years) at a cost of $1729 per additional life-year gained when we accounted for healthcare costs including the HBI.

Inglis, S. & Stewart, S. 2006, 'Metabolic therapeutics in angina pectoris: history revisited with perhexiline', European Journal of Cardiovascular Nursing, vol. 5, no. 2, pp. 175-184.
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Metabolic therapeutics in angina pectoris: history revisited with perhexiline

Pearson, S., Inglis, S., McLennan, S., Brennan, L., Russell, M., Wilkinson, D., Thompson, D. & Stewart, S. 2006, 'Prolonged effects of a home-based intervention in patients with chronic illness', Archives of Internal Medicine, vol. 166, no. 6, pp. 645-650.
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Background: Data on the long-term benefits of nonspecific disease management programs are limited. We performed a long-term follow-up of a previously published randomized trial. Methods: We compared all-cause mortality and recurrent hospitalization during median follow-up of 7.5 years in a heterogeneous cohort of patients with chronic illness initially exposed to a multidisciplinary, home-based intervention (HBI) (n = 260) or to usual postdischarge care (n = 268). Results: During follow-up, HBI had no impact on all-cause mortality (relative risk, 1.04; 95% confidence interval, 0.80+1.35) or event-free survival from death or unplanned hospitalization (relative risk, 1.03; 95% confidence interval, 0.86+1.24). Initial analysis suggested that HBI had only a marginal impact in reducing unplanned hospitalization, with 677 readmissions vs 824 for the usual care group (mean ¦ SD rate, 0.72 ¦ 0.96 vs 0.84 ¦ 1.20 readmissions/patient per year; P = .08). When accounting for increased hospital activity in HBI patients with chronic obstructive pulmonary disease during follow-up for 2 years, post hoc analyses showed that HBI reduced readmissions by 14% within 2 years in patients without this condition (mean ¦ SD rate, 0.54 ¦ 0.72 vs 0.63 ¦ 0.88 readmission/patient per year; P = .04) and by 21% in all surviving patients within 3 to 8 years (mean ¦ SD rate, 0.64 ¦ 1.26 vs 0.81 ¦ 1.61 readmissions/patient per year; P = .03). Overall, recurrent hospital costs were significantly lower (14%) in the HBI group (mean ¦ SD, $823 ¦ $1642 vs $960 ¦ $1376 per patient per year; P = .045).

Inglis, S., McLennan, S., Dawson, A., Birchmore, L., Horowitz, J.D., Wilkinson, D. & Stewart, S. 2004, 'A new solution for an old problem? Effects of a nurse-led, multidisciplinary, home-based intervention on readmission and mortality in patients with chronic atrial fibrillation.', Journal of Cardiovascular Nursing, vol. 19.

Ferguson, C., Inglis, S., Newton, P.J., Davidson, P.M. & Middleton, S. 2012, 'Atrial fibrillation and thromboprophylaxis: methods in risk assessment and addressing barriers to adherence: A review.', 'The Aging Heart' - Australian Cardiovascular Nursing College 6th Annual Scientific Meeting, Crowne Plaza, Coogee, Sydney, Australia., February 2012.
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Background: Globally, stroke is one of the worldÔ++s most prevalent, disabling and chronic conditions. Atrial fibrillation is a common arrhythmia in heart failure and presents a significant risk factor for thrombo-embolic, ischaemic stroke. Risk stratification schemata and therapies exist for the treatment of atrial fibrillation and the prophylaxis of stroke, however commonly these therapies are not applied in practice, even when advised in guidelines for numerous reasons. Objective: This presentation aims to identify available validated risk assessment tools for the prediction of stroke risk in patients with atrial fibrillation. Each tool will be evaluated for their benefits and limitations and their consequential implications for clinical practice. Barriers to adherence of available therapies will also be discussed in relation to stroke risk assessment tools and the World Health OrganizationÔ++s multidimensional adherence model (2003) Methods: A comprehensive electronic search of the following databases was undertaken: CINAHL, Medline, EBSCO Host, SCOPUS, and the Cochrane Library. Google and Google Scholar search engines were also used. Results: 6 risk prediction assessment tools featured heavily in the search results. Namely; AFI, SPAF, FRS, FGCRS, CHA2DS2 and CHA2DS2-VASc. Each are evaluated and discussed with regards to their advantage and limitations. Conclusions: Whilst valid risk assessment tools are available and their use recommended within practice guidelines their comprehensiveness and holistic patient assessment is questionable. To date, many risk prediction models focus on physical aspects of health and do not assess criteria related to psycho-social aspects of patientÔ++s health and wellbeing such as the patientÔ++s likeliness to adhere to anticoagulation therapy, their ability to take oral medications or assume responsibility for the safe monitoring of their INR. There is much scope for improvement in stroke risk prediction models in atrial fibrillation.

Ferguson, C., Inglis, S., Newton, P.J. & Davidson, P.M. 2012, 'Atrial fibrillation and thromboprophylaxis: methods in risk assessment and addressing barriers to adherence: A review.', 7th Annual N3 & ANNA NSW Neuroscience Symposium, North Sydney Harbourview Hotel, Sydney, March 2012.

Clark, R., Inglis, S., Stewart, S., McAlister, F. & Cleland, J.G. 2011, 'Complex Telemonitoring or a Simple Telephone Call, Which Is More Effective in Post-Discharge Heart Failure (HF) Management?', Boston, September 2011 in Journal of Cardiac Failure, ed Barry M Massie, Elsevier, Philidephia, p. S100.

Inglis, S., clark, r., Stewart, S., McAlister, F. & Cleland, J.G. 2011, 'Are Telemonitoring and Structured Telephone Support More Effective in Younger or Older Heart Failure Patients? A Sensitivity Analysis from a Cochrane Review.', Boston, September 2011 in Journal of Cardiac Failure, ed Barry M Massie, Elsevier, Philidephia, p. S90.

Karim, K., Lewsey, J. & Inglis, S. 2011, 'Trends of vascular surgery in Scotland 1991Ô++2007', Edinburgh, August 2011 in Journal of Epidemiology and Community Health, ed Martin Bobak, BMJ, London, p. A192.

Chang, S., Newton, P.J., Inglis, S., Luckett, T., Krum, H., Macdonald, P. & Davidson, P.M. 2013, 'Are all outcomes in chronic heart failure rated equally? An argument for a patient-centred approach to outcome assessment', Heart Failure Reviews, Springer, Netherlands.
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Chronic heart failure (CHF) is a multi-dimensional and complex syndrome. Outcome measures are important for determining both the efficacy and quality of care and capturing the patient's perspective in evaluating the outcomes of health care delivery. Capturing the patient's perspective via patient-reported outcomes is increasingly important; however, including objective measures such as mortality would provide more complete account of outcomes important to patients.

Inglis, S., Hermis, A., Shehab, S., Newton, P.J., Lal, S., Davidson, P.M. 2013, 'Peripheral arterial disease and chronic heart failure: a dangerous mix', Heart Failure Reviews, Springer, Netherlands.
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Chronic heart failure (CHF) is associated with a high comorbidity burden, adverse impact on quality of life and high health care utilisation. Peripheral arterial disease (PAD) and CHF share many risk, pathophysiological and prognostic features, and each has been associated with increased morbidity and mortality. PAD often goes undetected, and yet in spite of the availability of screening tools, this is not commonly considered in CHF care.