Electronic Medical Record Data Analysis for Early Diagnosis of Aortic Aneurysms
Anirudh Chandrashekar, Nicholas Stafford, Dorian Cohen, Joseph Adachi, Nishant Prashar, Ian Davidson, Samuel Akhnoukh, Vasilios Koulouris, Christopher Rosenberg, Aaron Zlatopolsky, Stella T. Tsui, Robert Hutnik, Georgios Tzavellas, MD, Rajeev Masson, MD, Nilima Lovekar, MPH, Apostolos Tassiopoulos, MD.
Stony Brook Medicine, Stony Brook, NY, USA.
OBJECTIVES: Abdominal Aortic Aneurysms (AAA) pose a significant mortality risk via rupture if undiagnosed. Large population screening programs for AAA resulted in significant decrease both in aneurysm related mortality and all-cause mortality, however, they are costly and capture only part of the population at risk. We used Electronic Medical Record (EMR) captured data to develop a program aiming to identify at-risk patients with aneurysmal disease.
METHODS: All EMR entries for the year 2017 at out institution were queried to identify patients meeting the criteria (1) ≥60 years old, and (2) history of smoking, as the baseline risk profile for AAA. Using image specific Current Procedural Terminology (CPT) codes for (1) thoracic and abdominal CT and MRI and (2) aortic duplex ultrasound, we identified those patients with previous images of the thoracic or abdominal aorta. These study reports were then retrospectively reviewed to identify patients with AAAs and thoracic aneurysms. We defined AAA as any dilatation of the abdominal aorta ≥ 2.5cm and as thoracic aneurysm dilatation of the thoracic aorta >3.5 cm. Patients without recorded imaging of the abdominal aorta were invited to an ultrasound based screening program, forming the prospective cohort. We compared AAA prevalence in both a prospective and retrospective group for comparison.
RESULTS: The retrospective cohort included a total of 2,016 patients and the prospective 200 patients who underwent a screening duplex ultrasound. After completing the pre-screening questionnaire, 27 of them were subsequently excluded after determining they were inaccurately recorded as having a smoking history in the EMR. The prevalence of abdominal aortic aneurysms was ~10% and not different in the two cohorts (Table 1). The prevalence of thoracic aneurysms in the retrospective cohort was 5.1%.
CONCLUSIONS: Using a simple risk profile filter to analyze EMR data, we were able to identify a patient cohort with a significant prevalence of AAA disease that matches the results of successful national screening programs in western countries. As most aneurysms captured were small, this program offers an opportunity for implementation of risk factor modification strategies and appropriate aneurysm follow up on this population.
| Retrospective Cohort | Prospective Cohort | ||||
| Ages | Patients | AAA | TAA | Patients | AAA |
| 60-69 | 617 | 47 | 19 | 88 | 7 |
| 70-79 | 820 | 77 | 43 | 75 | 9 |
| 80-89 | 481 | 53 | 38 | 10 | 1 |
| >90 | 98 | 14 | 3 | - | - |
| Total | 2016 | 191 (9.5%) | 103 (5.1%) | 173 | 17 (9.8%) |
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