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Lampridou S, Saghdaoui LB, Bicknell C, Kumlien C, Lear R. Health Related Quality of Life Following Intervention for Thoracoabdominal Aortic Aneurysm: A Systematic Review and Narrative Synthesis. Ann Vasc Surg 2024; 101:105-119. [PMID: 38160705 DOI: 10.1016/j.avsg.2023.10.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 10/25/2023] [Accepted: 10/26/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND Thoracoabdominal aortic aneurysms (TAAA) pose significant risks of morbidity and mortality. Considering the evolving techniques for TAAA intervention and the growing interest in quality of life (QoL) outcomes for decision-making, we aimed to evaluate the impact of patient and perioperative characteristics on short-term, medium-term, and long-term postoperative QoL in TAAA repair patients. METHODS A systematic search was conducted in CINAHL, APA PsycINFO, EMBASE, Medline and Cochrane to identify primary research studies evaluating QoL post TAAA surgery, published in English or Swedish between January 01, 2012 and September 26, 2022. A narrative synthesis was reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. The quality of evidence was assessed using the Critical Appraisal Skills Program and Joanna Briggs Institute checklists. RESULTS Eight studies of low or moderate quality with 455 patients were included. Preoperative QoL in TAAA patients was lower compared to the general population. While there is an initial short-term improvement in postoperative QoL, patients fail to reach baseline levels even after 7 years, with physical activity and functioning domains being particularly affected. Experiencing postoperative complications, including paraplegia and cardiovascular events, negatively impacts postoperative QoL. Patients with uncomplicated postoperative status had improved QoL. Prolonged hospital stay negatively affects physical functioning. CONCLUSIONS Individuals with TAAA are likely to have lower baseline QoL compared to the general population. Following TAAA repair, postoperative QoL may remain lower than baseline levels, persisting over the long-term. Comorbidities, postoperative complications, and hospitalization duration appear to exert adverse effects on postoperative QoL.
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Affiliation(s)
- Smaragda Lampridou
- Vascular Surgery Department, Imperial College Healthcare NHS Trust, London, UK; Faculty of Medicine, Department of Surgery & Cancer, Imperial College London, London, UK.
| | - Layla Bolton Saghdaoui
- Vascular Surgery Department, Imperial College Healthcare NHS Trust, London, UK; Faculty of Medicine, Department of Surgery & Cancer, Imperial College London, London, UK
| | - Colin Bicknell
- Vascular Surgery Department, Imperial College Healthcare NHS Trust, London, UK; Faculty of Medicine, Department of Surgery & Cancer, Imperial College London, London, UK
| | - Christine Kumlien
- Department of Care Science, Malmö University, Malmö, Sweden; Department of Cardiothoracic and Vascular Surgery, Skåne University Hospital, Malmö, Sweden
| | - Rachael Lear
- Institute of Global Health Innovation, NIHR Imperial Biomedical Research Centre, Imperial College London, London, UK
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Peres P, Lupson M, Dawson J. The benefits of a centralized remote surveillance program for vascular patients. J Vasc Surg 2023; 77:913-921. [PMID: 36356674 DOI: 10.1016/j.jvs.2022.10.045] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 09/30/2022] [Accepted: 10/31/2022] [Indexed: 11/09/2022]
Abstract
OBJECTIVE We aimed to assess the clinical and financial utility of a centralized remote surveillance program for vascular patients compared with traditional outpatient follow-up. METHODS In 2014, the Royal Adelaide Hospital Department of Vascular Surgery introduced a centralized remote surveillance program where suitable patients were monitored by remote imaging in lieu of traditional outpatient appointments (OPAs). Surveillance imaging was performed at a site local to the patient and was reviewed centrally by a dedicated surveillance nurse. We undertook a 5-year retrospective analysis of the program's prospectively maintained database since its inception. Costs for inpatient admissions and OPAs were retrieved from hospital financial databases. The surveillance database and electronic patient records were analyzed for number and outcome of surveillance scans, interventions, and OPAs. Additional savings in travel distance, fuel costs, and CO2 emissions were also calculated. RESULTS Over 5 years, 1262 patients underwent a mean of four scans per patient. A total of 3718 OPAs were saved, approximating 930 hours of clinic and consultant time, with associated savings of Australian (A)$1,524,900 (United States [US]$ 1,065,684) over 5 years (A$ 304,980 [US$ 213,137] per year). For every OPA avoided, each patient saved 197 km travel and A$87 (US$ 61) fuel costs, with an associated 115 kg of CO2 emissions saved. Over 5 years, this equated to savings of 248,173 km travel, A$ 110,136 (US$ 76,969) fuel costs, and 146 tons of CO2 emissions. A total of 134 surveillance-detected pathologies (10.6%) required intervention, a further 28 despite surveillance (2.2%), and three following surveillance cessation (0.2%). Subgroup analysis demonstrated that interventions despite surveillance were three times more expensive and incurred four times longer admissions than those due to surveillance. CONCLUSIONS Remote vascular surveillance, particularly applicable in our current COVID-19 pandemic climate, is associated with quantifiable financial, clinical, patient, and environmental beneficial outcomes and can be safely delivered to populations spanning large geographical areas such as those in Australia.
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Affiliation(s)
- Penelope Peres
- Department of Vascular and Endovascular Surgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia.
| | - Marianne Lupson
- Department of Vascular and Endovascular Surgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Joseph Dawson
- Department of Vascular and Endovascular Surgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia; Discipline of Surgery, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
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Hultgren R, Fattahi N, Nilsson O, Svensjö S, Roy J, Linne A. Evaluating feasibility of using national registries for identification, invitation, and ultrasound examination of persons with hereditary risk for aneurysm disease-detecting abdominal aortic aneurysms in first degree relatives (adult offspring) to AAA patients (DAAAD). Pilot Feasibility Stud 2022; 8:252. [PMID: 36503690 PMCID: PMC9742022 DOI: 10.1186/s40814-022-01196-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 10/31/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Sweden and the UK invite all 65-year-old men to a population-based ultrasound-based screening program to detect abdominal aortic aneurysms (AAA). First-degree relatives of patients with AAA are reported to have an increased risk to develop AAA, both women and men, but are not invited to screening. The "Detecting AAA in First Degree Relatives to AAA patients" (DAAAD) was designed to detect the true prevalence in adult offspring to AAA patients and to evaluate if national registries could be used for identification of index persons and their adult children with a high risk for the disease. The aim of this study is to summarize the design and methodology for this registry-based study. METHODS The study is based on a registry-based extraction and identification of a risk group in the population with a subsequent identification of their adult offspring. The targeted risk group suffers a heredity for a potentially lethal disease, AAA (n = 750) and matched control group without heredity for AAA is also identified and invited (n = 750). The participation rate in the population-based AAA screening program for men is 75% regionally. This population is younger and have a lower prevalence. A participation rate of 65% is considered clinically adequate. For the DAAAD study, a stratified analysis of the primary outcome, prevalence, will be performed for women and men separately. Two other planned projects are based on the material: firstly, evaluation of the anxiety for disease and health-related quality of life (HRQoL) and, secondly, the cost-effectiveness of the study. DISCUSSION In conclusion, this feasibility study will be instrumental in supporting the development of a possible new model to invite persons with high risk to develop hereditary rare diseases. To our knowledge, this is a unique, safe, and most likely to be a cost-efficient model to invite targeted risk groups for selected screening. If the study design and the results are shown to be cost-effective at the detected participation rate and prevalence, it should be further evaluated and adopted to a national screening program. The model also invites both women and men, which is unique for this specific patient group, considering that all population-based screening programs only include men. TRIAL REGISTRATION This trial is registered at the website of Clinical Trials. CLINICALTRIALS gov identifier, NCT4623268.
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Affiliation(s)
- Rebecka Hultgren
- grid.24381.3c0000 0000 9241 5705Department of Vascular Surgery, Karolinska University Hospital Stockholm, Stockholm, Sweden ,grid.4714.60000 0004 1937 0626Stockholm Aneurysm Research group, STAR, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Nina Fattahi
- grid.4714.60000 0004 1937 0626Department of Clinical Science and Education, Karolinska Institutet at Södersjukhuset, Stockholm, Sweden ,grid.416648.90000 0000 8986 2221Section of Vascular Surgery, Department of Surgery, Södersjukhuset, Stockholm, Sweden
| | - Olga Nilsson
- grid.24381.3c0000 0000 9241 5705Department of Vascular Surgery, Karolinska University Hospital Stockholm, Stockholm, Sweden ,grid.4714.60000 0004 1937 0626Stockholm Aneurysm Research group, STAR, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Sverker Svensjö
- grid.8993.b0000 0004 1936 9457Department of Surgical Sciences, Uppsala University, Uppsala, Sweden ,Centre for Clinical Research, Falun, Sweden
| | - Joy Roy
- grid.24381.3c0000 0000 9241 5705Department of Vascular Surgery, Karolinska University Hospital Stockholm, Stockholm, Sweden ,grid.4714.60000 0004 1937 0626Stockholm Aneurysm Research group, STAR, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Anneli Linne
- grid.4714.60000 0004 1937 0626Department of Clinical Science and Education, Karolinska Institutet at Södersjukhuset, Stockholm, Sweden ,grid.416648.90000 0000 8986 2221Section of Vascular Surgery, Department of Surgery, Södersjukhuset, Stockholm, Sweden
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Nilsson O, Stenman M, Letterstål A, Hultgren R. A randomized clinical trial of an eHealth intervention on anxiety in patients undergoing abdominal aortic aneurysm surgery. Br J Surg 2021; 108:917-924. [PMID: 34021309 PMCID: PMC10364917 DOI: 10.1093/bjs/znab151] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 04/10/2021] [Indexed: 11/12/2022]
Abstract
BACKGROUND The potential benefit of eHealth interventions in patients with abdominal aortic aneurysm (AAA) is uncertain. The primary aim of this study was to investigate the effect of an eHealth intervention on anxiety in patients with AAA undergoing surgery. METHODS A single-centre randomized clinical trial of patients with AAA scheduled for surgical repair was undertaken. The intervention group received an eHealth tool and psychosocial support besides standard care. The control group received standard care. The analysis of treatment effects was performed as intention-to-treat and per protocol analysis. The primary outcome measure was anxiety mean score (Hospital Anxiety and Depression Scale Anxiety (HADS)-A). Secondary outcomes measures were HADS Depression and short-form 12-item health survey mean scores. RESULTS Some 120 participants were randomized. No effect on anxiety mean scores was found in the intention-to-treat analysis (-1.21 versus -0.54, P = 0.330). Among those randomized to the intervention, only 30 of 60 participants used the eHealth tool (application (app) users). The app users were younger and had a higher educational level. A decrease in anxiety mean scores was noted in those who used the app in the per protocol analysis (-2.00 versus -0.54, P = 0.028). The intervention group stated a lower physical-component health-related quality of life (HRQoL) (-4.32 versus -1.16, P = 0.042) but mental-component HRQoL and depressive symptoms were unchanged. CONCLUSIONS Delivery of an eHealth intervention in this RCT did not result in an improvement in anxiety scores in patients awaiting AAA surgery. Uptake of the eHealth tool was low, although it resulted in lower anxiety scores in those participants who actually used it. CLINICAL TRIAL REGISTRATION NUMBER NCT03157973 (http://www.clinicaltrials.gov).
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Affiliation(s)
- O Nilsson
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.,Department of Vascular Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - M Stenman
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.,Perioperative Medicine and Intensive Care Function, Karolinska University Hospital, Stockholm, Sweden
| | - A Letterstål
- Department of Medicine, Karolinska Institutet, Stockholm, Sweden.,School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden
| | - R Hultgren
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.,Department of Vascular Surgery, Karolinska University Hospital, Stockholm, Sweden
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Ericsson A, Carlson E, Ching SSY, Molassiotis A, Kumlien C. Partners' experiences of living with men who have screening-detected abdominal aortic aneurysms: A qualitative descriptive study. J Clin Nurs 2020; 29:3711-3720. [PMID: 32619284 DOI: 10.1111/jocn.15399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 04/28/2020] [Accepted: 06/05/2020] [Indexed: 11/27/2022]
Abstract
AIM To describe partners' experiences of living with men with a screening-detected abdominal aortic aneurysm (AAA). BACKGROUND Diagnosis of a chronic life-threatening disease affects the patients' as well as their partners' lives in different aspects. AAA, with rupture as the major consequence, is a life-threatening disease that can affect the whole family. Screening programmes for AAA have been introduced in several countries to reduce the mortality rate. Although the awareness of having an AAA influences the individuals' quality of life and well-being, it is still unclear how it affects their partners. DESIGN Qualitative descriptive design. METHODS Twenty-one partners of men with AAA were purposely selected to participate in individual semi-structured interviews between August 2017-February 2018 in Sweden. Data were transcribed and imported into NVivo-12® . The data were analysed using qualitative content analysis. The study conforms to the COREQ checklist. RESULTS Three categories were identified: (a) experiencing the unexpected; (b) being reminded of fragility; and (c) balancing a changing relationship. The partners had a positive attitude towards the screening process and were pleased that their husbands were under surveillance. Nevertheless, at the same time, the diagnosis caused worries and questions. The AAA diagnosis was constantly in the minds of the partners, which sometimes affected and limited daily activities. Furthermore, ambivalent feelings towards surgical treatment were described. The partners tried to support their men and encouraged them to achieve a healthy lifestyle. CONCLUSION The partners' well-being and daily lives were impacted by the awareness of the screening-detected AAA. Different degrees of worry were the most common reaction and were pervasive in all three categories. RELEVANCE FOR CLINICAL PRACTICE The result highlights the need to review routines or develop new strategies to include the partners in the process of screening and offer supplementary support and information.
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Affiliation(s)
- Anna Ericsson
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, Hong Kong
| | | | | | - Alex Molassiotis
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, Hong Kong
| | - Christine Kumlien
- Department of Care Science, Malmö University, Malmö, Sweden.,Department of Cardiothoracic and Vascular Surgery, Skåne University Hospital, Malmö, Sweden
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Earnshaw JJ. Does quality of life really matter in a screening programme? Eur J Vasc Endovasc Surg 2019; 57:597. [DOI: 10.1016/j.ejvs.2018.11.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Accepted: 11/23/2018] [Indexed: 11/27/2022]
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