A new accurate, rapid and cost-effective protocol for stroke-prevention screening

Lavenson, George S.

doi:10.1016/s0967-2109(98)00083-0

Cited by 15 publications

(19 citation statements)

References 9 publications

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“…Our results found that 50% of individuals with ≥50% carotid stenosis had carotid bruit; its sensitivity as a predictor was 50%. Lavenson Jr. et al (30) screened 176 individuals to validate a stroke prevention protocol and found a carotid bruit rate similar to that identified in this study. Despite its low sensitivity, the presence of carotid bruit proved highly specific for the occurrence of carotid stenosis, yielding a negative predictive value of 0.99.…”

Section: Discussionsupporting

confidence: 76%

Carotid stenosis: what is the high-risk population?

Park

Razuk

Saad

et al. 2012

Clinics

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OBJECTIVE:Prevention is the best treatment for cerebrovascular disease, which is why early diagnosis and the immediate treatment of carotid stenosis contribute significantly to reducing the incidence of stroke. Given its silent nature, 80% of stroke cases occur in asymptomatic individuals, emphasizing the importance of screening individuals with carotid stenosis and identifying high-risk groups for the disease. The aim of this study was to determine the prevalence and the most frequent risk factors for carotid stenosis.METHODS:A transversal study was conducted in the form of a stroke prevention campaign held on three non-consecutive Saturdays. During the sessions, carotid stenosis diagnostic procedures were performed for 500 individuals aged 60 years or older who had systemic arterial hypertension and/or diabetes mellitus and/or coronary heart disease and/or a family history of stroke.RESULTS:The prevalence of carotid stenosis in the population studied was 7.4%, and the most frequent risk factors identified were mean age of 70 years, carotid bruit, peripheral obstructive arterial disease, coronary insufficiency and smoking. Independent predictive factors of carotid stenosis include the presence of carotid bruit or peripheral obstructive arterial disease and/or coronary insufficiency.CONCLUSIONS:The population with peripheral obstructive arterial disease and/or coronary insufficiency and carotid bruit should undergo routine screening for carotid stenosis.

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Section: Discussionsupporting

confidence: 76%

Carotid stenosis: what is the high-risk population?

Park

Razuk

Saad

et al. 2012

Clinics

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“…The 30 studies were of mixed designs from nine countries, including 26 prospective cohort studies (1,17,, two retrospective cohort studies (16,44) and two randomised controlled trials both comparing opportunistic with systematic screening (45, 46) (▶ Table 1). Participants were recruited from either GP or outpatient clinics (12 studies), (16,(20)(21)(22)(23)(24)(25)(26)(27)(44)(45)(46) or community advertisements or population screening (18 studies) (1,17,(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41)(42)(43).…”

Section: Study Selection and Characteristicsmentioning

confidence: 99%

“…cancer). Screening methods differed between studies: the majority used ECG (1,16,17,21,22,(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(35)(36)(37)(38)(39)(40)(41)(42)(43)(44), three pulse palpation (20,23,34), and two a combination of these (45,46). Screening results are outlined in ▶ Table 1.…”

Section: Study Selection and Characteristicsmentioning

confidence: 99%

Screening to identify unknown atrial fibrillation

Lowres

Neubeck²,

Redfern³

et al. 2013

Thromb Haemost

279

106

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Atrial fibrillation (AF) is associated with a significantly increased stroke risk which is highly preventable with appropriate oral anticoagulant therapy (OAC). However, AF may be asymptomatic and unrecognised prior to stroke. We aimed to determine if single time-point screening for AF could identify sufficient numbers with previously undiagnosed AF, to be effective for stroke prevention. This is a systematic review of clinical trials, by searching electronic medical databases, reference lists and grey literature. Studies were included if they evaluated a general ambulant adult population, using electrocardiography or pulse palpation to identify AF. We identified 30 individual studies (n=122,571, mean age 64 years, 54% male) in nine countries. Participants were recruited either from general practitioner and outpatient clinics (12 studies) or population screening/community advertisements (18 studies). Prevalence of AF across all studies was 2.3% (95% CI, 2.2-2.4%), increasing to 4.4% (CI, 4.1-4.6%) in those ≥65 years (16 studies, n= 27,884). Overall incidence of previously unknown AF (14 studies, n=67,772) was 1.0% (CI, 0.89-1.04%), increasing to 1.4% (CI, 1.2-1.6%) in those ≥65 years (8 studies, n= 18,189) in whom screening setting did not influence incidence identified. Of those with previously unknown AF, 67% were at high risk of stroke.Screening can identify 1.4% of the population ≥65 years with previously undiagnosed AF. Many of those identified would be eligible for, and benefit from OAC to prevent stroke. Given this incidence, community AF screening strategies in at risk older age groups could potentially reduce the overall health burden associated with AF.

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“…For that reason, a stroke prevention screening (SPS) protocol was developed to provide a rapid, accurate, and cost-effective means of screening for carotid artery disease, atrial fibrillation, and hypertension that is applicable for mass SPS of seniors. 6,7…”

Section: Methodsmentioning

confidence: 99%

The American Vascular Association Screening Program: Rationale, Method, Guidelines, and Progress

Lavenson

2005

Journal for Vascular Ultrasound

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Introduction The Society of Vascular Surgery, in partnership with the Society for Vascular Ultrasound (SVU), established a National Vascular Screening Program thru the American Vascular Association (AVA). The program screens for the immediate causes of stroke, abdominal aortic aneurysms (AAA), and peripheral vascular disease. Detection of these conditions while the patient still is asymptomatic allows for early management and avoidance of the devastating events they can cause. Methods A quick carotid scan is used for detection of carotid artery disease, an EKG rhythm strip for atrial fibrillation, blood pressure determination for hypertension, a quick abdominal scan for AAA, and ankle/brachial indices for peripheral vascular disease. The SVU position on screening, recommending credentialed technologists and accredited laboratories, is used in the AVA screening program, and reporting only the presence or absence of disease has been recommended. Results The AVA program, and three other programs reported, screened 6,073 seniors. It is estimated that the carotid screenings alone prevented 30 strokes and saved $12,061,400,000 in stroke costs. Conclusion The AVA screening program, with quality ensured by the SVU guidelines, has the potential to prevent a major number of strokes and deaths. Recommendation is for extension of the screening program and for efforts to obtain Medicare funding for the screening.

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A new accurate, rapid and cost-effective protocol for stroke-prevention screening

Cited by 15 publications

References 9 publications

Carotid stenosis: what is the high-risk population?

Carotid stenosis: what is the high-risk population?

Screening to identify unknown atrial fibrillation

The American Vascular Association Screening Program: Rationale, Method, Guidelines, and Progress

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