Screening Older Adult Men for Abdominal Aortic Aneurysm: A Scoping Review

Abdominal aortic aneurysm (AAA) is a potentially fatal condition predominantly affecting older adult men (60 years or over). Based on evidence, preventative health-care guidelines recommend screening older males for AAA using ultrasound. In attempts to reduce AAA mortality among men, screening has been utilized for early detection in some Western countries including the UK and Sweden. The current scoping review includes 19 empirical studies focusing on AAA screening in men. The findings from these studies highlight benefits and potential harms of male AAA screening. The benefits of AAA screening for men include decreased incidence of AAA rupture, decreased AAA mortality, increased effectiveness of elective AAA repair surgery, and cost-effectiveness. The potential harms of AAA screening included lack of AAA mortality reduction, negative impacts on quality of life, and inconsistent screening eligibility criteria being applied by primary care practitioners. The current scoping review findings are discussed to suggest changes to AAA screening guidelines and improve policy and practice.

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Extended screening guidelines for the diagnosis of abdominal aortic aneurysm

Journal of Vascular Surgery ◽

10.1016/j.jvs.2020.03.047 ◽

2020 ◽

Vol 72 (6) ◽

pp. 1917-1926 ◽

Cited By ~ 1

Author(s):

Matthew L. Carnevale ◽

Issam Koleilat ◽

Evan C. Lipsitz ◽

Patricia Friedmann ◽

Jeffrey E. Indes

Keyword(s):

Abdominal Aortic Aneurysm ◽

Aortic Aneurysm ◽

Screening Guidelines ◽

Abdominal Aortic

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COST-EFFECTIVENESS OF TARGETED SCREENING FOR ABDOMINAL AORTIC ANEURYSM

International Journal of Technology Assessment in Health Care ◽

10.1017/s0266462300016135 ◽

2000 ◽

Vol 16 (1) ◽

pp. 22-34 ◽

Cited By ~ 7

Author(s):

Tuomo Johannes Pentikäinen ◽

Teemu Sipilä ◽

Pekka Rissanen ◽

Sari Soisalon-Soininen ◽

Jarmo Salo

Keyword(s):

Abdominal Aortic Aneurysm ◽

Cost Effectiveness ◽

Aortic Aneurysm ◽

Incremental Cost ◽

Empirical Studies ◽

Epidemiological Studies ◽

Point Estimate ◽

Abdominal Aortic ◽

Life Years ◽

Targeted Screening

Objectives: This article reports a cost-effectiveness analysis of targeted screening for abdominal aortic aneurysm (AAA). A major emphasis was on the estimation of distributions of costs and effectiveness.Methods: We performed a Monte Carlo simulation using C programming language in a PC environment. Data on survival and costs, and a majority of screening probabilities, were from our own empirical studies. Natural history data were based on the literature.Results: Each screened male gained 0.07 life-years at an incremental cost of FIM 3,300. The expected values differed from zero very significantly. For females, expected gains were 0.02 life-years at an incremental cost of FIM 1,100, which was not statistically significant. Cost-effectiveness ratios and their 95% confidence intervals were FIM 48,000 (27,000–121,000) and 54,000 (22,000–∞) for males and females, respectively. Sensitivity analysis revealed that the results for males were stable. Individual variation in life-year gains was high.Conclusions: Males seemed to benefit from targeted AAA screening, and the results were stable. As far as the cost-effectiveness ratio is considered acceptable, screening for males seemed to be justified. However, our assumptions about growth and rupture behavior of AAAs might be improved with further clinical and epidemiological studies. As a point estimate, females benefited in a similar manner, but the results were not statistically significant. The evidence of this study did not justify screening of females.

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Faculty Opinions recommendation of Extended screening guidelines for the diagnosis of abdominal aortic aneurysm.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.737809965.793579634 ◽

2020 ◽

Author(s):

Norman Hertzer

Keyword(s):

Abdominal Aortic Aneurysm ◽

Aortic Aneurysm ◽

Screening Guidelines ◽

Abdominal Aortic

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Abstract P057: The Association Between Diabetes and Risk of Abdominal Aortic Aneurysm: A Meta-Analysis

Circulation ◽

10.1161/circ.137.suppl_1.p057 ◽

2018 ◽

Vol 137 (suppl_1) ◽

Author(s):

Lu Yao ◽

Aaron Folsom ◽

Alvaro Alonso ◽

James Pankow ◽

Weihua Guan ◽

...

Keyword(s):

Abdominal Aortic Aneurysm ◽

Relative Risk ◽

Aortic Aneurysm ◽

Meta Analysis ◽

Case Control ◽

Outcome Variable ◽

P Value ◽

Published Data ◽

Eligibility Criteria ◽

Abdominal Aortic

Objectives: Data regarding the relationship between diabetes and abdominal aortic aneurysm (AAA) are inconsistent across studies: some studies showed an inverse relationship while others did not show an association. We conducted a meta-analysis to examine the association between diabetes and AAA based on published data from case-control and cohort studies. Methods: We searched literature in English from online databases including MEDLINE (1966-), EMBASE and Web of Science as of July 2017, plus a manual examination of references in selected articles. The eligibility criteria included (1) a case-control or cohort study conducted in adults; (2) diabetes is the exposure variable and AAA risk is the outcome variable; and (3) association estimates (hazard ratios, odds ratios or relative risks) and measurement of variance (P value, confidence interval, or standard error) were available. The literature review and data abstraction were conducted in duplicate by independent investigators. A DerSimonian and Laird random effects model was used to pool association estimates and their 95% confidence intervals from studies using STATA 13. The Cochran’s Q test was used to assess the presence of heterogeneity and the I-square index to quantify the extent of heterogeneity. Results: We included in the meta-analyses a total of 10 cohorts with 10,771 AAAs in 2,625,318 participants and 4 case-control studies with 1,065 AAAs and 11,009 controls that met the pre-determined eligibility criteria. The samples were predominantly white (88%). Study-specific relative risk and pooled relative risk as well as heterogeneity test results were shown in Figure. Diabetes was inversely associated with AAA risk (pooled relative risk: 0.55; 95%CI: 0.49 - 0.61, Figure) . Results were overall consistent by sex, study design and setting (hospital- vs community-based). Conclusions: The findings suggest that diabetes is strongly and inversely associated with the risk of AAA. Future studies are warranted to investigate the potential mechanisms.

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