Impact of the Screening Abdominal Aortic Aneurysms Very Efficiently (SAAAVE) Act on Abdominal Ultrasonography Use Among Medicare Beneficiaries

Shreibati, Jacqueline Baras; Baker, Laurence C.; Hlatky, Mark A.; Mell, Matthew W.

doi:10.1001/archinternmed.2012.4268

Cited by 61 publications

(37 citation statements)

References 26 publications

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“…Despite the introduction of the SAAAVE Act in 2007, screening for AAA remains underutilized [19]. Additionally, more recent data suggest that the implementation of the SAAAVE Act has not had any discernible effect on AAA rupture rate or AAA-related mortality, presumably due to its severe underutilization [20]. …”

Section: Clinical Studies On Aaamentioning

confidence: 99%

Update on Abdominal Aortic Aneurysm Research: From Clinical to Genetic Studies

et al. 2014

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An abdominal aortic aneurysm (AAA) is a dilatation of the abdominal aorta with a diameter of at least 3.0 cm. AAAs are often asymptomatic and are discovered as incidental findings in imaging studies or when the AAA ruptures leading to a medical emergency. AAAs are more common in males than females, in individuals of European ancestry, and in those over 65 years of age. Smoking is the most important environmental risk factor. In addition, a positive family history of AAA increases the person's risk for AAA. Interestingly, diabetes has been shown to be a protective factor for AAA in many large studies. Hallmarks of AAA pathogenesis include inflammation, vascular smooth muscle cell apoptosis, extracellular matrix degradation, and oxidative stress. Autoimmunity may also play a role in AAA development and progression. In this Outlook paper, we summarize our recent studies on AAA including clinical studies related to surgical repair of AAA and genetic risk factor and large-scale gene expression studies. We conclude with a discussion on our research projects using large data sets available through electronic medical records and biobanks.

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Section: Clinical Studies On Aaamentioning

confidence: 99%

Update on Abdominal Aortic Aneurysm Research: From Clinical to Genetic Studies

et al. 2014

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“…However, this is a fairly narrow screening program, and it has been shown that the SAAAVE Act has had no discernable effect on AAA rupture or all-cause mortality [7]. …”

Section: Introductionmentioning

confidence: 99%

Modeling the Burden of Abdominal Aortic Aneurysm in the USA in 2013

Stuntz¹

2016

Cardiology

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Objectives: Abdominal aortic aneurysm (AAA) is a pathological condition characterized by an abnormal, localized dilatation of the lower part of the aorta. Due to a lack of data on the natural history of AAA and risk of death from other cardiovascular diseases attributable to AAA, the true number of AAA-attributable deaths may be higher than currently estimated. This study aims to produce more realistic estimates of the burden of AAA. Methods: A disease-modeling software, DisMod II, was used to assess the AAA burden via a multistate life table. Inputs included population, all-cause mortality, size- and sex-specific AAA prevalence, and relative risk of death estimates for persons with AAA compared with persons without AAA. Results: There were 2,347,339 prevalent cases of AAA in the USA in 2013 (95% CI: 2,131,964-2,524,116), resulting in 41,371 deaths attributable to AAA (95% CI: 34,090-49,234). Females constituted 21.1% of prevalent cases and 45.2% of deaths, compared with males constituting 78.9% of prevalent cases and 54.8% of deaths. Conclusions: This work shows that the burden of mortality attributable to AAA is more than twice the current estimates from the American Heart Association. Females account for a disproportionately high percentage of deaths despite constituting a low percentage of prevalent cases.

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“…AAA screening using a hand-held ultrasound device was faster for early detection: our study required only 4 minutes per patient. Moreover, it would be cheaper than traditional AAA screening programs that have a modest effect on AAA rupture or all-cause mortality [55,56] with an estimated cost per patient of $53 [57]. Some recent opinions suggest ultra sound should be brought to the point of patient care, and should be in the black bag of every general practitioner [58,59], or should form part of the periodic physical examination [60].…”

Section: Discussionmentioning

confidence: 99%

Abdominal aortic aneurysm screening program using hand-held ultrasound in primary healthcare

et al. 2017

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We determined the feasibility of abdominal aortic aneurysm (AAA) screening program led by family physicians in public primary healthcare setting using hand-held ultrasound device. The potential study population was 11,214 men aged ≥ 60 years attended by three urban, public primary healthcare centers. Participants were recruited by randomly-selected telephone calls. Ultrasound examinations were performed by four trained family physicians with a hand-held ultrasound device (Vscan®). AAA observed were verified by confirmatory imaging using standard ultrasound or computed tomography. Cardiovascular risk factors were determined. The prevalence of AAA was computed as the sum of previously-known aneurysms, aneurysms detected by the screening program and model-based estimated undiagnosed aneurysms. We screened 1,010 men, with mean age of 71.3 (SD 6.9) years; 995 (98.5%) men had normal aortas and 15 (1.5%) had AAA on Vscan®. Eleven out of 14 AAA-cases (78.6%) had AAA on confirmatory imaging (one patient died). The total prevalence of AAA was 2.49% (95%CI 2.20 to 2.78). The median aortic diameter at diagnosis was 3.5 cm in screened patients and 4.7 cm (p<0.001) in patients in whom AAA was diagnosed incidentally. Multivariate logistic regression analysis identified coronary heart disease (OR = 4.6, 95%CI 1.3 to 15.9) as the independent factor with the highest odds ratio. A screening program led by trained family physicians using hand-held ultrasound was a feasible, safe and reliable tool for the early detection of AAA.

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Impact of the Screening Abdominal Aortic Aneurysms Very Efficiently (SAAAVE) Act on Abdominal Ultrasonography Use Among Medicare Beneficiaries

Abstract: The impact of the SAAAVE Act on AAA screening was modest and was based on abdominal ultrasonography use that it did not directly reimburse. The SAAAVE Act had no discernable effect on AAA rupture or all-cause morality.

Cited by 61 publications

References 26 publications

Update on Abdominal Aortic Aneurysm Research: From Clinical to Genetic Studies

Update on Abdominal Aortic Aneurysm Research: From Clinical to Genetic Studies

Modeling the Burden of Abdominal Aortic Aneurysm in the USA in 2013

Abdominal aortic aneurysm screening program using hand-held ultrasound in primary healthcare

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