Can a Frailty Index Score Aid in the Decision to Stop Abdominal Aortic Aneurysm (AAA) Surveillance or Turn Down a Patient for Elective Infrarenal AAA Repair?

Abstract

Objective: It is purported that patients with peripheral arterial disease (PAD) may have impaired cognitive function due to concomitant cerebrovascular disease. Such disease may be clinically unrecognised but can impact on a patient's recovery and prognosis. The purpose of this systematic review was to interrogate the body of published evidence on undiagnosed dementia in PAD patients. Methods: A search strategy encompassing MEDLINE, Scopus, and the Cochrane database was developed to identify peer reviewed articles examining rates of undiagnosed dementia in patients with PAD. The following search terms were used: "PAD"; "PVD"; "dementia"; "peripheral arterial disease"; "peripheral vascular disease"; "cognitive impairment"; "Alzheimer's disease", and "cogniti". The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2009 guidelines were followed throughout. The primary outcome was the incidence of previously undiagnosed dementia in patients with PAD. Results: The initial electronic literature search yielded 1 492 titles. After removal of duplicates, 994 abstracts were screened in order to ascertain if they were potentially eligible for inclusion. Abstract review yielded 62 full texts for further evaluation, and from this eight caseecontrol studies consisting of 1 161 patients were included in the review. Analysis of these studies revealed that PAD patients performed significantly worse than controls on a variety of neuropsychological measures of executive function (six out of eight studies). Conclusion: The review indicated that PAD patients are more likely to have undiagnosed dementia than healthy controls. This condition may impact on their ability to comply with treatment strategies and should be borne in mind when managing this challenging patient cohort.

Establishment of a clinical nurse specialist-led, virtual aneurysm surveillance clinic

“…40 Interestingly, assessment by our clinical nurse specialist correlated well with formal frailty scores and confirms further the value of this system of surveillance. 41 COVID-19 restrictions impacted the provision of radiology appointments as significantly as ADCC services. In order to reduce unnecessary exposure to healthcare environments and to ensure social distancing, all non-emergent imaging appointments were cancelled.…”

“…40 Interestingly, assessment by our clinical nurse specialist correlated well with formal frailty scores and confirms further the value of this system of surveillance. 41…”