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Non-traditional Risk Factors that Influence Follow-up Attendance of Patients with Abdominal Aortic Aneurysms
Sukhmine Baines, MA, MD1, Kevin C. Chun, BS2, Ashley S. Schmidt, BA2, Jacqulyne H. Sylvia, BS2, Kiana M. Samadzadeh, BS2, Eugene S. Lee, MD, PhD1.
1University of California, Davis, Sacramento, CA, USA, 2Sacramento VA Medical Center, Sacramento, CA, USA.
OBJECTIVES: An active regional Veterans Affairs (VA) abdominal aortic aneurysm (AAA) screening program identified 652 patients with an intermediate size AAA (3.0 - 5.4 cm diameter) within a 5 year period. Typically, treatment for these AAA is ultrasound surveillance. We hypothesize that non-traditional risk factors can influence whether an AAA patient attends their follow-up appointment. The purpose of this study is to identify which non-traditional risk factors influence surveillance follow-up rates of intermediate sized AAA patients.
METHODS: A retrospective chart review of Veterans with a detected AAA from a large screening program from January 1, 2007 to December 31, 2011 was conducted.Non-traditional risk factors such as initial AAA diameter, assisted living status, employment eligibility (according to current VA eligibility criteria), marital status, and distance between home and the medical center were recorded. Follow-up was defined as receiving a follow up image at least 180 days after initial AAA screening. Both follow-up and no follow-up groups were compared for significance.
RESULTS: A total of 476 AAA patients were enrolled in this study with a follow up rate of 49% (231/476) (Table). During the follow-up period, 19.2% of patients in the no follow-up group died versus 10.0% in the follow-up group (p<.001). Non-traditional risk factors that were significantly associated with follow-up rates were AAA diameter ≥ 4 cm (p<.001) and being eligible for employment (p=0.02). Being married (p=0.047) and living further away from the hospital (p=0.04) were
associated with not following-up.
CONCLUSIONS: Smaller aortic diameter, not being eligible for employment, greater distance to the hospital, and being married are associated with patients failing to follow-up. Further study is needed to determine whether being married is detrimental to making follow-up appointments.
Table | No Follow Up (n=245) | Follow-Up (n=231) | P-Value | | AAA Diameter ≥ 4 cm | 17.1% | 32.5% | p<.001 | | Assisted Living | 13.1% | 12.6% | 0.87 | Eligible
for employment | 88.6% | 94.4% | 0.02 | | Married | 56.7% | 47.6% | 0.047 | Average Distance to Hospital
(mi) | 125±299 | 89±106 | 0.04 |
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