Comparison of three targeted approaches to screening for abdominal aortic aneurysm based on cardiovascular risk

Jones, Gregory T.; Hill, Brigid G.; Curtis, Nicole; Kabir, Tasnuva D.; Wong, Leighton; Tilyard, Murray; Williams, Michael J.A.; Rij, A.M. M. van

doi:10.1002/bjs.10224

Cited by 32 publications

(19 citation statements)

References 25 publications

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“…Therefore, an effective screening plan could be valuable to prevent extreme AA dilation and rupture and appropriately address high risk patients towards surgery. The importance of an early detection of AA dilatation has been indirectly proven by the observation that AAA and AA rupture can be reasonably excluded in old patients with abdominal pain admitted in emergency department if they had a normal AA size on a previously performed computed tomography or ultrasound exam [31]. A recent study has also shown that a systematic and targeted approach based on CV risk assessment could be very useful to identify undiagnosed cases [32].…”

Section: Discussionmentioning

confidence: 99%

Identification of the main determinants of abdominal aorta size: a screening by Pocket Size Imaging Device

Esposito

Ilardi

Lomoriello

et al. 2017

Cardiovasc Ultrasound

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BackgroundUltrasound exam as a screening test for abdominal aorta (AA) can visualize the aorta in 99% of patients and has a sensitivity and specificity approaching 100% in screening settings for aortic aneurysm. Pocket Size Imaging Device (PSID) has a potential value as a screening tool, because of its possible use in several clinical settings. Our aim was to assess the impact of demographics and cardiovascular (CV) risk factors on AA size by using PSID in an outpatient screening.MethodsConsecutive patients, referring for a CV assessment in a 6 months period, were screened. AA was visualized by subcostal view in longitudinal and transverse plans in order to determine the greatest anterior-posterior diameter. After excluding 5 patients with AA aneurysm, 508 outpatients were enrolled. All patients underwent a sequential assessment including clinical history with collection of CV risk factors, physical examination, PSID exam and standard Doppler echoc exam using a 2.5 transducer with harmonic capability, both by expert ultrasound operators, during the same morning. Standard echocardiography operators were blinded on PSID exam and viceversa.ResultsDiagnostic accuracy of AA size by PSID was tested successfully with standard echo machine in a subgroup (n = 102) (rho = 0.966, p < 0.0001). AA diameter was larger in men than in women and in ≥50 -years old subjects than in those <50 -years old (both p < 0.0001). AA was larger in patients with coronary artery disease (CAD) (p < 0.0001). By a multivariate model, male sex (p < 0.0001), age and body mass index (both p < 0.0001), CAD (p < 0.01) and heart rate (p = 0.018) were independent predictors of AA size (cumulative R 2 = 0.184, p < 0.0001).ConclusionPSID is a reliable tool for the screening of determinants of AA size. AA diameter is greater in men and strongly influenced by aging and overweight. CAD may be also associated to increased AA diameter.

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Section: Discussionmentioning

confidence: 99%

Identification of the main determinants of abdominal aorta size: a screening by Pocket Size Imaging Device

Esposito

Ilardi

Lomoriello

et al. 2017

Cardiovasc Ultrasound

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“…The association with more CVD risk factors and with CVD history suggests to use the same risk assessment tool used for major CVD, like CVD risk scores. This was the second aim of the RoCAV study, very recently addressed also by Jones et al in selected populations [41]. Our study will address this question in the context of a large sample, randomly selected from the general population.…”

Section: Discussionmentioning

confidence: 92%

Prevalence of abdominal aortic aneurysms and its relation with cardiovascular risk stratification: protocol of the Risk of Cardiovascular diseases and abdominal aortic Aneurysm in Varese (RoCAV) population based study

Gianfagna

Veronesi

Bertù

et al. 2016

BMC Cardiovasc Disord

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BackgroundRecent meta-analyses suggested that screening program for abdominal aortic aneurysms (AAA) in 65-year old males is cost-effective at prevalence of about 1%. Since some events occur also in females and among the youngers, screening could be feasible among those at higher risk, such as smokers or individuals with a family history of AAA. The RoCAV (Risk of Cardiovascular diseases and abdominal aortic Aneurysms in Varese) Project is a population-based study aimed to evaluate AAA prevalence in Northern Italy in males over-65 years as well as among females and younger males, and to identify new markers for risk stratification by collecting a large set of CVD risk factors. The aims of the project are: (i) cross-sectional evaluation of AAA prevalence (ii); evaluation of standard CVD risk score as criteria for selecting subgroup at higher risk to be included in a screening program; (iii) identification of new risk markers and risk score algorithm for AAA and CVD risk stratification; (iv) cost-effective evaluation during the follow-up.MethodsMales aged 50–75 years and females aged 60–75 years, resident in the city of Varese (Lombardy Region), were randomly selected from the civil registry. Among 5198 successfully invited, 3777 subjects accepted to participate and were finally recruited (participation rate 63.8%) from June 2013 to May 2016. Trained operators administered a computerized anamnestic questionnaire, measured anthropometric parameters (BMI, body circumferences, skinfolds), blood pressure, ankle-brachial index, pulse wave velocity and performed abdominal aortic ultrasound scan, ECG and spirometry. All methods were internationally validated. A blood sample was collected and stored in biobank. A follow-up will be carried out through linkage with electronic records.DiscussionParticipation rate and data quality assessment were as expected and will reasonably allow to reach the project aims. The expected impact in public health of the RoCAV project will be the potential implementation of a AAA screening program to the whole region as well as the formulation of new criteria for risk assessment of AAA and CVD.

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“…An AAA screening programme specifically targeted towards higher‐risk groups was not part of this analysis. This is an area of growing interest, for example screening targeted at those with a proven burden of cardiovascular disease or a raised 5‐year cardiovascular risk score, with the goal of a higher AAA detection rate. Separate modelling and assessment would be required for this approach.…”

Section: Discussionmentioning

confidence: 99%

“…Estimating the prevalence of AAA in New Zealand men aged 65 years was difficult given the absence of large population‐based prevalence studies. There have been several smaller AAA prevalence studies in New Zealand between 2005 and 2014. Although they were conducted in different populations and using different imaging modalities, they showed an AAA prevalence in men aged 65 years of between 3 and 8 per cent, particularly in the larger studies that most closely represented a general population.…”

Section: Methodsmentioning

confidence: 99%

Health gains, costs and cost-effectiveness of a population-based screening programme for abdominal aortic aneurysms

Nair

Kvizhinadze

Jones

et al. 2019

British Journal of Surgery

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Background Abdominal aortic aneurysm (AAA) rupture carries a high fatality rate. AAAs can be detected before rupture by abdominal ultrasound imaging, allowing elective repair. Population‐based screening for AAA in older men reduces AAA‐related mortality by about 40 per cent. The UK began an AAA screening programme offering one‐off scans to men aged 65 years in 2009. Sweden has a similar programme. Currently, there is no AAA screening programme in New Zealand. This cost–utility analysis aimed to assess the cost‐effectiveness of a UK‐style screening programme in the New Zealand setting. Methods The analysis compared a formal AAA screening programme (one‐off abdominal ultrasound imaging for about 20 000 men aged 65 years in 2011) with no systematic screening. A Markov macrosimulation model was adapted to estimate the health gains (in quality‐adjusted life‐years, QALYs), health system costs and cost‐effectiveness in New Zealand. A health system perspective and lifetime horizon was adopted. Results With New Zealand‐specific inputs, the adapted model produced an estimate of about NZ $15 300 (€7746) per QALY gained, with a 95 per cent uncertainty interval (UI) of NZ $8700 to 31 000 (€4405 to 15 694) per QALY gained. Health gains were estimated at 117 (95 per cent UI 53 to 212) QALYs. Health system costs were NZ $1·68 million (€850 535), with a 95 per cent UI of NZ $820 200 to 3·24 million (€415 243 to €1·65 million). Conclusion Using New Zealand's gross domestic product per capita (about NZ $45 000 or €22 100) as a cost‐effectiveness threshold, a UK‐style AAA screening programme would be cost‐effective in New Zealand.

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Comparison of three targeted approaches to screening for abdominal aortic aneurysm based on cardiovascular risk

Cited by 32 publications

References 25 publications

Identification of the main determinants of abdominal aorta size: a screening by Pocket Size Imaging Device

Identification of the main determinants of abdominal aorta size: a screening by Pocket Size Imaging Device

Prevalence of abdominal aortic aneurysms and its relation with cardiovascular risk stratification: protocol of the Risk of Cardiovascular diseases and abdominal aortic Aneurysm in Varese (RoCAV) population based study

Health gains, costs and cost-effectiveness of a population-based screening programme for abdominal aortic aneurysms

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