Yield of Repeated Screening for Abdominal Aortic Aneurysm After a 4-Year Interval (original) (raw)
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The long-term benefits of a single scan for abdominal aortic aneurysm (AAA) at age 65
European Journal of …, 2001
Aim: to investigate the efficacy of a single ultrasonic scan at age 65 to identify patients at risk from ruptured abdominal aortic aneurysm (AAA). Method: a total of 6058 men aged 64-81 were recruited to a randomised trial, and 3000 were invited to attend a single screening test. An additional population of 1011 men was offered screening as they reached age 65. If a normal aorta was identified in this subgroup , further scans were offered at two-yearly intervals. Follow up and treatment of those identified as having an aortic dilatation of 3 cm or greater was undertaken. All subject groups were monitored for deaths occurring over the study period, and date and cause of death were recorded. Results: a total of 2212 men attended screening in the randomised trial; the overall compliance was 74%, and prevalence of AAA was 7.7%. Compliance decreased, and prevalence increased, with age. Mortality from ruptured AAA was reduced by 68% at 5 years (screened group compared to the age-matched control population), and by 42% in the study arm (screened and refusers) compared with controls. The benefit persisted at ten years (53% and 21% respectively). Of the uncontrolled sample of 1011 men offered a scan at age 65, 681 attended and 649 of these were found to have a normal aortic diameter; re-screening demonstrated new aneurysm development in 4% over ten years. The aortic diameters of the new AAAs were under 4 cm and would therefore have a low risk of rupture. 1 Mortality from rupture in all those with an initially normal aortic diameter was low, at 1 case per 1000 scans over ten years. Conclusion: screening once for AAA at age 65 can identify the majority of AAA that are of clinical significance and can identify a large population at low risk from rupture who do not require surveillance. This policy has been effective when combined with selective treatment in reducing the risk of rupture for ten years in those who attend the screening programme.
An abdominal aortic aneurysm screening programme for all males over the age of 50 years
European Journal of Vascular Surgery, 1994
Previously published ultrasound screening programmes for abdominal aortic aneurysm (AAA) have concentrated on males in the 65 to 75 year age range, suggesting this as the most cost-effective cohort to target. In this unique study we have broadened the criteria for screening. General practitioners in one health district were approached to supply details of all males aged 50 years and over to be offered aortic ultrasound scanning. Over a period of 18 months, 4145 individuals were asked to attend and 3030 (73%) have attended. Attendance rates were: between 50 and 64 years, 73%; between 65 and 79 years, 75%;for 80 years and over, 64%-significantly less (p = 0.01-0.001) than the other two age bands. Aortic dilatation (diameter ~ 2.5 cm) was found in 6.3 % of the 50 to 64 year age group, 16.8 % of the 65 to 79 year age group, and 23.3 % of the 80 years and over age group. A n established aneurysm (>~4.6cm) was found in 0.3%-6 individuals (50-64 years), 2.5% (65-79 years) and 4.1% (>180 years). The results suggest that aortic screening may be worthwhile extending to a wider age band. By focusing follow-up, this should give greater value for younger men in terms of community productivity and allows for selective intervention in the elderly.
Screening Older Adult Men for Abdominal Aortic Aneurysm: A Scoping Review
American Journal of Men's Health, 2021
Abdominal aortic aneurysm (AAA) is a potentially fatal condition predominantly affecting older adult men (60 years or over). Based on evidence, preventative health-care guidelines recommend screening older males for AAA using ultrasound. In attempts to reduce AAA mortality among men, screening has been utilized for early detection in some Western countries including the UK and Sweden. The current scoping review includes 19 empirical studies focusing on AAA screening in men. The findings from these studies highlight benefits and potential harms of male AAA screening. The benefits of AAA screening for men include decreased incidence of AAA rupture, decreased AAA mortality, increased effectiveness of elective AAA repair surgery, and cost-effectiveness. The potential harms of AAA screening included lack of AAA mortality reduction, negative impacts on quality of life, and inconsistent screening eligibility criteria being applied by primary care practitioners. The current scoping review f...
BMJ, 2004
Objective To assess whether screening for abdominal aortic aneurysms in men reduces mortality. Design Population based randomised controlled trial of ultrasound screening, with intention to treat analysis of age standardised mortality. Setting Community based screening programme in Western Australia. Participants 41 000 men aged 65-83 years randomised to intervention and control groups. Intervention Invitation to ultrasound screening. Main outcome measure Deaths from abdominal aortic aneurysm in the five years after the start of screening.
Screening for abdominal aortic aneurysms: single centre randomised controlled trial
BMJ, 2005
Objective To determine whether screening Danish men aged 65 or more for abdominal aortic aneurysms reduces mortality. Design Single centre randomised controlled trial. Setting All five hospitals in Viborg County, Denmark. Participants All 12 639 men born during 1921-33 and living in Viborg County. In 1994 we included men born 1921-9 (64-73 years). We also included men who became 65 during 1995-8. Interventions Men were randomised to the intervention group (screening by abdominal ultrasonography) or control group. Participants with an abdominal aortic aneurysm > 5 cm were referred for surgical evaluation, and those with smaller aneurysms were offered annual scans. Outcome measures Specific mortality due to abdominal aortic aneurysm, overall mortality, and number of planned and emergency operations for abdominal aortic aneurysms. Results 4860 of 6333 men were screened (attendance rate 76.6%). 191 (4.0% of those screened) had abdominal aortic aneurysms. The mean follow-up time was 52 months. The screened group underwent 75% (95% confidence interval 51% to 91%) fewer emergency operations than the control group. Deaths due to abdominal aortic aneurysms occurred in nine patients in the screened group and 27 in the control group. The number needed to screen to save one life was 352. Specific mortality was significantly reduced by 67% (29% to 84%). Mortality due to non-abdominal aortic aneurysms was non-significantly reduced by 8%. The benefits of screening may increase with time. Conclusion Mass screening for abdominal aortic aneurysms in Danish men aged 65 or more reduces mortality.
JAMA internal medicine, 2016
Mortality from ruptured abdominal aortic aneurysms (AAAs) remains high. The benefit of screening older men for AAAs needs to be assessed in a range of health care settings. To assess the influence of screening for AAAs in men aged 64 to 83 years on mortality from AAAs. This randomized clinical trial performed from April 1, 1996, through March 31, 1999, with a mean of 12.8 years of follow-up (range, 11.6-14.2 years) included a population-based sample from a single metropolitan region in Western Australia identified via the electoral roll. Data analysis was performed from June 1, 2015, to June 1, 2016. Randomization to an invitation to undergo ultrasonography of the abdominal aorta or a control group without invitation. Surgery for and mortality from AAA. A total of 49 801 men aged 64 to 83 years were identified for the study. Men living too far from screening centers (n = 8671) or who died before invitation (n = 2650) were excluded, resulting in 19 249 men in the invited group and 19...
Ultrasound screening for abdominal aortic aneurysms
Schweizerische Medizinische Wochenschrift, 2017
QUESTIONS UNDER STUDY: This pilot study aimed to assess the feasibility, acceptance and costs of an ultrasound scan screening programme for abdominal aortic aneurysms (AAA) in the elderly male population resident in Canton Ticino, Switzerland. METHODS: The target population were male patients aged 65-80 years who attended the outpatient clinics of the Lugano Regional Hospital in 2013. The patients showing interest were contacted by phone to verify their eligibility and fix the appointment for the ultrasound scan of the abdominal aorta. Patients with recent examinations suitable for AAA detection were excluded. Aneurysm was defined as an abdominal aorta with sagittal and/or axial diameter ≥ 30 mm. Patients' characteristics and study results were presented as descriptive statistics. The chi-squared test was used to compare categorical variables with p <0.05 as a statistical significance threshold. RESULTS: 1634 patients received the screening information leaflet and 745 (45.6%) underwent the ultrasound scan. Among the 1091 eligible patients, the acceptance rate was 68.3%. A previously unknown AAA was diagnosed in 31 patients (4.2%, 95% confidence interval 2.8-5.9%). Age and area of residence had a statistically significant impact on patient's acceptance rate (p <0.05). The mean cost per screened patient was CHF 88. CONCLUSIONS: AAA screening of male patients aged 65-80 years is feasible with limited financial and organisational effort. Adherence might be improved by a larger community-based programme and involvement of general practitioners.
The influence of screening on the incidence of ruptured abdominal aortic aneurysms☆☆☆★
Journal of Vascular Surgery, 1999
Ruptured abdominal aortic aneurysms (AAAs) are responsible for 1.4% of all the deaths in men over the age of 65 years in the United Kingdom. 1 In 1994, there were 5580 deaths attributed to ruptured AAAs in England and Wales (International Classification of Disease codes, 444.3 and 444.5). 2 Almost half of all the deaths from ruptured AAAs occur outside the hospital, 3-6 and, for those cases that reach a hospital, the operative mortality of emergency repair of ruptured AAA lies between 30% and 50%. 7-11 Thus, the overall mortality of ruptured AAA is more than 80%. 3-6 Most of these deaths are potentially preventable because the elective repair of an asymptomatic AAA can have an operative mortality of less than 5%. Because it is easy to detect an AAA with ultrasound scanning, a screening program for all men over the age of 50 years was started in Huntingdon. Five years after the start of the program, three quarters of the eligible male population had been invited to participate. This report is an evaluation of the impact of the first 5 years of the screening program on the incidence rate of ruptured AAA in Huntingdon.