Comparative Effectiveness Of Abdominal Aortic Aneurysm Screening Under Current Guidelines And When Expanded To Female Smokers
Varun K. Dalmia, BA, Matthew Carnevale, MD, Antoine Pham, BA, John Denesopolis, MD, Evan C. Lipsitz, MD, MBA, Jeffrey E. Indes, MD.
Albert Einstein College of Medicine, Bronx, NY, USA.
OBJECTIVES: Recent data has highlighted that the commonly accepted USPSTF screening recommendations may only capture one-third of patients ultimately requiring operative repair for abdominal aortic aneurysm (AAA). The impact of expanded screening guidelines to include female smokers, as recommended by the SVS, remains to be shown. We examined the utilization of AAA screening based on accepted and expanded guidelines to evaluate if screening was associated with improved outcomes when compared to patients incidentally diagnosed.
METHODS: Using the TriNetX Analytics Network, patients with a diagnosis of unruptured AAA were identified. Those without relevant (screening/abdominal/retroperitoneal) imaging studies within 2 months prior to diagnosis were excluded. Two cohorts were abstracted: Ever-smoker males aged 65-75 (“USPSTF”), and ever-smoker females >65 years of age (“SVS”). Screened patients were identified as having a designated screening ultrasound for AAA prior to diagnosis. Those without history of screening and with records of other imaging modalities within 2 months of diagnosis were denoted as incidentally diagnosed. Long-term clinical outcomes between those screened and incidentally diagnosed were compared.
RESULTS: There were 18,141 patients with unruputured AAA meeting USPSTF criteria with 9.5% having a history of screening. There were 9,761 female smokers aged >65 with unruptured AAA with 3.5% having been screened. Of the USPSTF group, AAA rupture was more common among those diagnosed incidentally versus those screened at 1-year (2.1% vs. 0.58%, p<0.001) and 5-years (3.2% vs. 0.58%, p<0.001). Mortality was also greater in those diagnosed incidentally at 1-year (6.7% vs. 1.6%, p<0.001) and 5-years (14.5% vs. 3.2%, p<0.001). Among female smokers, rupture was more common in those screened at 1-year (1.5% vs. 3.0%, p=0.03) and similar at 5-years (2.5% vs. 3.0%, p=0.56). Mortality was increased in those diagnosed incidentally at 1-year (9.5% vs. 3.3%, p<0.001) and 5-years (18.5% vs. 6.5%, p<0.001).
CONCLUSIONS: These findings demonstrate an overall underutilization of screening in practice, as most patients were diagnosed incidentally. Patients diagnosed by screening had lower rates of rupture and lower mortality rates. Female smokers who were screened versus those incidentally diagnosed had superior outcomes which may support the benefit of screening these individuals by expanding current USPSTF guidelines. Further studies of screening expansion to guidelines in potentially vulnerable patient groups is warranted.
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