The 10-year Outcomes of a Regional Abdominal Aortic Aneurysm Screening Program
Kevin Chun, BS, Kelly Dolan, BS, Hunter Smothers, BS, Zachary Irwin, BS, Arlene Gonzalves, BSN, Eugene Lee, MD, PhD.
VA Northern California Health Care System, Sacramento, CA, USA.
OBJECTIVES: In 2007, Medicare established ultrasound screening guidelines to identify patients at risk for abdominal aortic aneurysm (AAA). The purpose of this study is to evaluate the first 10-year outcomes of an AAA screening program within a regional health care system.
METHODS: A retrospective chart review of all patients screened for AAA from 2007 until 2016 within a regional Veterans Affairs health care system was conducted. Screening criteria were males 65-75 years of age that smoked a minimum of 100 cigarettes in their lifetime. An AAA was defined as a maximum aortic diameter ≥3 cm. A comparison of the AAA diagnosis rate and clinical adherence rate of screening criteria between the first 5 years and total years were also evaluated.
RESULTS: A total of 19,664 patients (70.7 ± 4.9 years of age, mean ± standard deviation) were screened from January 1, 2007 to December 31, 2016. There were 9,916 new patients screened from 2012 to 2016. A total of 1,235 aneurysms (6.3% total patients) were identified within the 10-year analysis. The overall AAA diagnosis rate has declined from 7.2% in the first 5 years to 6.3% in 10 years (13.5% decrease, p<.01). There were 66 patients with AAA ≥5.5cm (5.3% of AAAs). A total of 3,680 patients screened (18.7%) did not meet screening criteria: 593 patients were <65 years of age, 3,087 patients were >75 years of age, and 59 patients were women. This rate has declined from 28.2% within the first 5 years to 18.7% in 10 years (33.7% decrease, p<.01).
CONCLUSIONS: The overall 10-year rate of AAA diagnosis from screening has declined from the first 5 years of implementation. The rate of inappropriate screenings has also declined, which may reveal better clinician awareness of AAA screening criteria.
|Group||Number||% AAAs or Total|
|2.5 - 2.9 cm||3211||16.3 (Total)|
|3.0 - 4.4 cm||1021||82.7 (AAAs)|
|4.5 - 5.4 cm||148||12.0 (AAAs)|
|>5.5 cm||66||5.3 (AAAs)|
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