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Mansoor SM, Jørgensen JJ, Hisdal J, Rabben T. Thirty-nine percent of patients with a ruptured abdominal aortic aneurysm (AAA) have an incidentally detected AAA prior to rupture. Ann Vasc Surg 2024:S0890-5096(24)00293-0. [PMID: 38942371 DOI: 10.1016/j.avsg.2024.04.017] [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: 01/31/2024] [Revised: 03/26/2024] [Accepted: 04/07/2024] [Indexed: 06/30/2024]
Abstract
INTRODUCTION Abdominal aortic aneurysm (AAA) screening has been offered to 65-year-old men living in Oslo, Norway, since May 2011. A significant number of AAA-related deaths occurred in individuals who are not eligible for screening. The primary aim of this study was to describe the group of patients admitted to Oslo University Hospital with a ruptured AAA after the implementation of the local AAA screening project. The following parameters were investigated: AAA detection prior to rupture, surveillance status, eligibility for screening and comorbidities. We also sought to compare outcomes (repair rates and 30-day mortality) between patients with and without an AAA detected prior to rupture. METHODS This cohort study included patients admitted acutely to Oslo University Hospital due to a symptomatic or ruptured AAA in the period January 2011 to December 2022. Data on demographics, prior AAA detection, surveillance status, treatment and mortality were collected retrospectively through electronic medical records. RESULTS We identified 200 patients with a symptomatic or ruptured AAA, among which 79 (40%) had an AAA detected prior to rupture - one (1%) through screening and 78 (39%) incidentally. Up to 30% of the incidentally detected AAAs were not under any surveillance. Six patients were found eligible for screening: one had attended, three were non-attenders and two had not been invited. Patients with an incidentally detected AAA prior to rupture had a more advanced age and a significantly higher degree of comorbidities than patients without a previously detected AAA, and the repair rates in these groups were 56% and 84% respectively (p < 0.001). Adjusted for comorbidities and risk factors, the odds ratio for repair among patients with incidentally detected AAA was 0.56 (p = 0.292). The 30-day mortality was not significantly different between the two groups (p = 0.097). CONCLUSION Most patients with a ruptured AAA were not eligible for screening, but 39% of the patients had an incidentally detected AAA prior to rupture. Standardized reporting and follow-up of incidentally detected AAAs is thus identified as an additional measure to organized screening in the effort to reduce AAA-related mortality.
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Affiliation(s)
- Saira Mauland Mansoor
- Department of Vascular Surgery, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.
| | - Jørgen Joakim Jørgensen
- Department of Vascular Surgery, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; Department of Traumatology, Oslo University Hospital, Oslo, Norway
| | - Jonny Hisdal
- Department of Vascular Surgery, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Toril Rabben
- Department of Vascular Surgery, Oslo University Hospital, Oslo, Norway
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Heyman H, Blom J, Saraste D. Colorectal cancer screening with faecal immunochemical test: Patterns of participation. J Med Screen 2024; 31:15-20. [PMID: 37464838 PMCID: PMC10877995 DOI: 10.1177/09691413231188275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 05/31/2023] [Accepted: 06/22/2023] [Indexed: 07/20/2023]
Abstract
OBJECTIVE To evaluate participation and participation patterns in a population-based screening programme for colorectal cancer (CRC) using the faecal immunochemical test (FIT). METHODS All individuals invited to three consecutive screening rounds in the population-based CRC screening between October 2015 and December 2020 in the Stockholm-Gotland Region, Sweden were included. Patterns of participation were assessed. RESULTS The study included 26 541 individuals which resulted in 79 623 screening events. The overall uptake rate was 71.5% and women had a significantly higher participation rate. The participation rate increased significantly between the first and third screening round for both men and women, and the increase was larger among men than women (66.1 to 70.7% vs. 73.1 to 75.4%). In total, 80.9% participated at least once. Consistent participation was the most common participation pattern (61.0%). The probability of attending all three consecutive rounds after initial participation was 87.7%. Over the three rounds, 17.4% participated after a reminder letter. Screening individuals attending after a reminder letter had a higher proportion of drop-outs in the following screening round compared to initial participants (15.4% vs 6.2%). CONCLUSION A constant and high participation rate was observed in population-based FIT-screening for CRC. Initial participation was a strong predictor for continuous participation. The need for a reminder letter before participation was a risk factor for subsequent drop-out.
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Affiliation(s)
- Hanna Heyman
- Department of Surgery, Södersjukhuset, Stockholm and Department of Clinical Science and Education, Karolinska Institutet, Stockholm, Sweden
| | - Johannes Blom
- Department of Surgery, Södersjukhuset, Stockholm and Department of Clinical Science and Education, Karolinska Institutet, Stockholm, Sweden
| | - Deborah Saraste
- Department of Surgery, Södersjukhuset, Stockholm and Department of Clinical Science and Education, Karolinska Institutet, Stockholm, Sweden
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Prendes CF, Gouveia E Melo R, Caldeira D, D'Oria M, Tsilimparis N, Koelemay M, Van Herzeele I, Wanhainen A. Editor's Choice - Systematic Review and Meta-Analysis of Contemporary Abdominal Aortic Aneurysm Growth Rates. Eur J Vasc Endovasc Surg 2024; 67:132-145. [PMID: 37777049 DOI: 10.1016/j.ejvs.2023.09.039] [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: 11/15/2022] [Revised: 08/17/2023] [Accepted: 09/21/2023] [Indexed: 10/02/2023]
Abstract
OBJECTIVE To evaluate the contemporary growth rate of small abdominal aortic aneurysms (AAAs) in view of recent epidemiological changes, such as decreasing smoking rates and establishment of population screening programmes. DATA SOURCES MEDLINE, CENTRAL, PsycINFO, Web of Science Core Collection, and OpenGrey databases. REVIEW METHODS Systematic review following the PRISMA guidelines. In October 2021, databases were queried for studies reporting on AAA growth rates published from 2015 onwards. The primary outcome was contemporary AAA growth rates in mm/year. Data were pooled in a random effects model meta-analysis, and heterogeneity was assessed through the I2 statistic. GRADE assessment of the findings was performed. The protocol was published in PROSPERO (CRD42022297404). RESULTS Of 8 717 titles identified, 43 studies and 28 277 patients were included: 1 241 patients from randomised controlled trials (RCTs), 23 941 from clinical observational studies, and 3 095 from radiological or translational research studies. The mean AAA growth rate was 2.38 mm/year (95% CI 2.16 - 2.60 mm/year; GRADE = low), with meta-regression analysis adjusted for baseline diameter showing an increase of 0.08 mm/year (95% CI 0.024 - 0.137 mm/year; p = .005) for each millimetre of increased baseline diameter. When analysed by study type, the growth rate estimated from RCTs was 1.88 mm/year (95% CI 1.69 - 2.06 mm/year; GRADE = high), while it was 2.31 mm/year (95% CI 1.95 - 2.67 mm/year; GRADE = moderate) from clinical observational studies, and 2.85 mm/year (95% CI 2.44 - 3.26 mm/year; GRADE = low) from translational and radiology based studies (p < .001). Heterogeneity was high, and small study publication bias was present (p = .003), with 27 studies presenting a moderate to high risk of bias. The estimated growth rate from low risk studies was 2.09 mm/year (95% CI 1.87 - 2.32; GRADE = high). CONCLUSION This study estimated a contemporaneous AAA growth rate of 2.38 mm/year, being unable to demonstrate any clinically meaningful AAA growth rate reduction concomitant with changed AAA epidemiology. This suggests that the RESCAN recommendations on small AAA surveillance are still valid. However, sub-analysis results from RCTs and high quality study data indicate potential lower AAA growth rates of 1.88 - 2.09 mm/year, findings that should be validated in a high quality prospective registry.
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Affiliation(s)
- Carlota F Prendes
- Department of Vascular Surgery, Ludwig Maximilians University Hospital, Munich, Germany.
| | - Ryan Gouveia E Melo
- Vascular Surgery Department, Hospital Santa Maria, Centro Hospitalar Universitário Lisboa Norte (CHULN), Centro Cardiovascular da Universidade de Lisboa (CCUL@RISE), Faculdade de Medicina da Universidade de Lisboa, Centro Académico de Medicina de Lisboa, Lisbon, Portugal
| | - Daniel Caldeira
- Cardiology Department, Hospital Santa Maria, Centro Hospitalar Universitário Lisboa Norte (CHULN), Centro Cardiovascular da Universidade de Lisboa (CCUL@RISE), Centro de Estudos de Medicina Baseada na Evidência (CEMB), Faculdade de Medicina da Universidade de Lisboa, Centro Académico de Medicina de Lisboa, Lisbon, Portugal
| | - Mario D'Oria
- Division of Vascular and Endovascular Surgery, Cardiovascular Department, University Hospital of Trieste ASUGI, Trieste, Italy
| | - Nikolaos Tsilimparis
- Department of Vascular Surgery, Ludwig Maximilians University Hospital, Munich, Germany
| | - Mark Koelemay
- Department of Surgery, Amsterdam UMC, location AMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
| | - Isabelle Van Herzeele
- Department of Thoracic and Vascular Surgery, Ghent University Hospital, Ghent, Belgium
| | - Anders Wanhainen
- Department of Surgical Sciences, Section of Vascular Surgery, Uppsala, Sweden; Department of Peri-operative and Surgical Sciences, Section of Surgery, Umeå University, Umeå, Sweden
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Leone N, Broda MA, Eiberg JP, Resch TA. Systematic Review and Meta-Analysis of the Incidence of Rupture, Repair, and Death of Small and Large Abdominal Aortic Aneurysms under Surveillance. J Clin Med 2023; 12:6837. [PMID: 37959301 PMCID: PMC10648148 DOI: 10.3390/jcm12216837] [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: 09/05/2023] [Revised: 10/24/2023] [Accepted: 10/25/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND The ultimate goal of treating patients with abdominal aortic aneurysms (AAAs) is to repair them when the risk of rupture exceeds the risk of repair. Small AAAs demonstrate a low rupture risk, and recently, large AAAs just above the threshold (5.5-6.0 cm) seem to be at low risk of rupture as well. The present review aims to investigate the outcomes of AAAs under surveillance through a comprehensive systematic review and meta-analysis. METHODS PubMed, Embase, and the Cochrane Central Register were searched (22 March 2022; PROSPERO; #CRD42022316094). The Cochrane and PRISMA statements were respected. Blinded systematic screening of the literature, data extraction, and quality assessment were performed by two authors. Conflicts were resolved by a third author. The meta-analysis of prevalence provided estimated proportions, 95% confidence intervals, and measures of heterogeneity (I2). Based on I2, the heterogeneity might be negligible (0-40%), moderate (30-60%), substantial (50-90%), and considerable (75-100%). The primary outcome was the incidence of AAA rupture. Secondary outcomes included the rate of small AAAs reaching the threshold for repair, aortic-related mortality, and all-cause mortality. RESULTS Fourteen publications (25,040 patients) were included in the analysis. The outcome rates of the small AAA group (<55 mm) were 0.3% (95% CI 0.0-1.0; I2 = 76.4%) of rupture, 0.6% (95% CI 0.0-1.9; I2 = 87.2%) of aortic-related mortality, and 9.6% (95% CI 2.2-21.1; I2 = 99.0%) of all-cause mortality. During surveillance, 21.4% (95% CI 9.0-37.2; I2 = 99.0%) of the initially small AAAs reached the threshold for repair. The outcome rates of the large AAA group (>55 mm) were 25.7% (95% CI 18.0-34.3; I2 = 72.0%) of rupture, 22.1% (95% CI 16.5-28.3; I2 = 25.0%) of aortic-related mortality, and 61.8% (95% CI 47.0-75.6; I2 = 89.1%) of all-cause mortality. The sensitivity analysis demonstrated a higher rupture rate in studies including <662 subjects, patients with a mean age > 72 years, >17% of female patients, and >44% of current smokers. CONCLUSION The rarity of rupture and aortic-related mortality in small AAAs supports the current conservative management of small AAAs. Surveillance seems indicated, as one-fifth reached the threshold for repair. Large aneurysms had a high incidence of rupture and aortic-related mortality. However, these data seem biased by the sparse and heterogeneous literature overrepresented by patients unfit for surgery. Specific rupture risk stratified by age, gender, and fit-for-surgery patients with large AAAs needs to be further investigated.
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Affiliation(s)
- Nicola Leone
- Department of Vascular Surgery, Rigshospitalet, 2200 Copenhagen, Denmark; (M.A.B.); (J.P.E.); (T.A.R.)
- Department of Vascular Surgery, Ospedale Civile di Baggiovara, Azienda Ospedaliero-Universitaria di Modena, University of Modena and Reggio Emilia, 41126 Modena, Italy
| | - Magdalena Anna Broda
- Department of Vascular Surgery, Rigshospitalet, 2200 Copenhagen, Denmark; (M.A.B.); (J.P.E.); (T.A.R.)
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, 1172 København, Denmark
| | - Jonas Peter Eiberg
- Department of Vascular Surgery, Rigshospitalet, 2200 Copenhagen, Denmark; (M.A.B.); (J.P.E.); (T.A.R.)
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, 1172 København, Denmark
- Copenhagen Academy of Medical Education and Simulation (CAMES), 2100 København, Denmark
| | - Timothy Andrew Resch
- Department of Vascular Surgery, Rigshospitalet, 2200 Copenhagen, Denmark; (M.A.B.); (J.P.E.); (T.A.R.)
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, 1172 København, Denmark
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Broeren M, Langenskiöld M, Pettersson ME. Psychosocial consequences after screening of abdominal aortic aneurysm among 65 year old men. JOURNAL OF VASCULAR NURSING 2023; 41:95-102. [PMID: 37684096 DOI: 10.1016/j.jvn.2023.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 04/28/2023] [Accepted: 05/09/2023] [Indexed: 09/10/2023]
Abstract
BACKGROUND In order to reduce the incidence of abdominal aortic aneurysm rupture and mortality, the Swedish Medical Council has introduced a national abdominal aortic aneurysm (AAA) screening program that offers ultrasound examination of 65-year-old men. Screening programmes of AAA may confer both benefits and harms. The study aim was to investigate the psychosocial consequences of AAA screening among men with screening-detected AAA as compared to men identified as AAA-negative at screening, using an AAA-specific questionnaire. METHODS This cross-sectional study investigated the psychosocial consequences of AAA screening measured with a condition-specific questionnaire. This study focused on the Experience of the Diagnosis and the Screening Procedure in terms of Anxiety, Sense of Dejection and Existential Values. One hundred and fifty-eight men with AAA (63%) and 275 with normal aorta size (55%) completed the diagnosis-specific questionnaire. RESULTS Ninety-six percent of men with screening detected AAA did not regret the screening examination, the corresponding figure for controls being 99.6%. Seventy percent of AAA patients were surprised that something was wrong in their body. Some (85%) of men with AAA were current or previous smokers, about half of them (45%) felt guilty about it and 78% of the current smokers in the AAA group had considered stopping smoking. Both groups considered changing lifestyle, although at a higher rate (32%) among AAA cases than controls (20%), with differences both in intention to change their ways to exercise (p = 0.019) and food intake (p = 0.001). Intergroup differences were identified for the majority of items as captured by the questionnaire where men identified with AAA reported more negative psycho-social consequences for all evaluated items except for the items: Regret of the screening examination (p = 0.069) and feeling terrified (p = 0.10). Fifty-one percent of AAA cases stated that they feared rupture, and 12% were anxious about rupture during sexual activity whereas 57% were worried about rupture during intense physical activity. CONCLUSION Men who were diagnosed with AAA reported more psychosocial consequences compared to controls; still only a minority of AAA cases reported psychosocial consequences in greater occurrence. To some degree, men with AAA also feared rupture during various types of activities. There appears to be a need for improved patient information and easy access to caregivers for men with screening-detected AAA, which might help to reduce psychosocial consequences associated with the diagnosis.
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Affiliation(s)
- Monica Broeren
- Department of Vascular Surgery, Sahlgrenska University Hospital, SE-416 85 Gothenburg, Sweden.
| | - Marcus Langenskiöld
- Department of Vascular Surgery and Institute of Medicine, Department of Molecular and Clinical Medicine, Sahlgrenska University Hospital and Sahlgrenska Academy, University of Gothenburg, SE-416 85 Gothenburg, Sweden
| | - Monica E Pettersson
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg; Department of Vascular Surgery, Sahlgrenska University Hospital, SE-416 85 Gothenburg, Sweden
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Mansoor SM, Rabben T, Hisdal J, Jørgensen JJ. Eleven-Year Outcomes of a Screening Project for Abdominal Aortic Aneurysm (AAA) in 65-Year-Old Men. Vasc Health Risk Manag 2023; 19:459-467. [PMID: 37485231 PMCID: PMC10361273 DOI: 10.2147/vhrm.s412954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 06/13/2023] [Indexed: 07/25/2023] Open
Abstract
Objective Since 2011, the Department of Vascular Surgery at Oslo University Hospital has offered screening for abdominal aortic aneurysm (AAA) to 65-year-old men living in Oslo, Norway. The aim of this study was to evaluate the effect of the screening project on AAA-related mortality and rupture and repair rates in the screened population. Methods This cohort study included men that participated in AAA screening at the Department of Vascular Surgery at Oslo University Hospital in the period May 2011 to September 2019. All men with screen-detected AAA (aortic diameter ≥30 mm) and subaneurysmal aortic dilatation (aortic diameter 25-29 mm) were included. A stratified (1:1 with the subaneurysm group), randomized selection of men with normal aortic diameter (<25 mm) upon screening was also included. The follow-up data on events (ruptures, repairs, and deaths) after screening were collected retrospectively from patient electronic medical records at Oslo University Hospital, the National Population Register and the Norwegian Cause of Death Registry (CoDR). Results In total, 2048 men were included, with a median follow-up time of 7.1 years (IQR 3.8). Among men with screen-detected AAA, 0.6% died of AAA-related causes (0.9 AAA-related deaths per 1000 person-years). The rupture rate was 0.3% among men with screen-detected AAA or subaneurysmal aortic dilatation, giving an incidence of 0.5 ruptures per 1000 person-years. The overall repair rate in the AAA group was 20.6% (36.1 repairs per 1000 person-years) and 0.6% (0.9 repairs per 1000 person-years) in the subaneurysm group. Conclusion In a population screened for AAA, the incidence of rupture and the AAA-related mortality was very low. Almost one-fifth of the participants with screen-detected AAA underwent elective repair, representing a group that might have presented with rupture if untreated. These results indicate that screening is valuable in preventing AAA rupture and AAA-related mortality.
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Affiliation(s)
- Saira Mauland Mansoor
- Department of Vascular Surgery, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Toril Rabben
- Department of Vascular Surgery, Oslo University Hospital, Oslo, Norway
| | - Jonny Hisdal
- Department of Vascular Surgery, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Jørgen Joakim Jørgensen
- Department of Vascular Surgery, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Traumatology, Oslo University Hospital, Oslo, Norway
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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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Lyth J, Svennberg E, Bernfort L, Aronsson M, Frykman V, Al-Khalili F, Friberg L, Rosenqvist M, Engdahl J, Levin LÅ. Cost-effectiveness of population screening for atrial fibrillation: the STROKESTOP study. Eur Heart J 2022; 44:196-204. [PMID: 36349968 PMCID: PMC9839418 DOI: 10.1093/eurheartj/ehac547] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 08/24/2022] [Accepted: 09/19/2022] [Indexed: 11/10/2022] Open
Abstract
AIMS Previous studies on the cost-effectiveness of screening for atrial fibrillation (AF) are based on assumptions of long-term clinical effects. The STROKESTOP study, which randomised 27 975 persons aged 75/76 years into a screening invitation group and a control group, has a median follow-up time of 6.9 years. The aim of this study was to estimate the cost-effectiveness of population-based screening for AF using clinical outcomes. METHODS AND RESULTS The analysis is based on a Markov cohort model. The prevalence of AF, the use of oral anticoagulation, clinical event data, and all-cause mortality were taken from the STROKESTOP study. The cost for clinical events, age-specific utilities, utility decrement due to stroke, and stroke death was taken from the literature. Uncertainty in the model was considered in a probabilistic sensitivity analysis. Per 1000 individuals invited to the screening, there were 77 gained life years and 65 gained quality-adjusted life years. The incremental cost was €1.77 million lower in the screening invitation group. Gained quality-adjusted life years to a lower cost means that the screening strategy was dominant. The result from 10 000 Monte Carlo simulations showed that the AF screening strategy was cost-effective in 99.2% and cost-saving in 92.7% of the simulations. In the base-case scenario, screening of 1000 individuals resulted in 10.6 [95% confidence interval (CI): -22.5 to 1.4] fewer strokes (8.4 ischaemic and 2.2 haemorrhagic strokes), 1.0 (95% CI: -1.9 to 4.1) more cases of systemic embolism, and 2.9 (95% CI: -18.2 to 13.1) fewer bleedings associated with hospitalization. CONCLUSION Based on the STROKESTOP study, this analysis shows that a broad AF screening strategy in an elderly population is cost-effective. Efforts should be made to increase screening participation.
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Affiliation(s)
- Johan Lyth
- Corresponding authors. Tel: +46739584822, (E.S.); Tel: +46 13 28 29 84, (J.L.)
| | - Emma Svennberg
- Corresponding authors. Tel: +46739584822, (E.S.); Tel: +46 13 28 29 84, (J.L.)
| | - Lars Bernfort
- Department of Health, Medicine and Caring Sciences, Linköping University, SE-581 83 Linköping, Sweden
| | - Mattias Aronsson
- Department of Health, Medicine and Caring Sciences, Linköping University, SE-581 83 Linköping, Sweden,AstraZeneca Nordics, SE-18257 Södertälje, Sweden
| | - Viveka Frykman
- Karolinska Institutet, Division of Cardiovascular Medicine, Department of Clinical Sciences, Danderyd University Hospital, Stockholm, Sweden
| | - Faris Al-Khalili
- Karolinska Institutet, Division of Cardiovascular Medicine, Department of Clinical Sciences, Danderyd University Hospital, Stockholm, Sweden
| | - Leif Friberg
- Karolinska Institutet, Division of Cardiovascular Medicine, Department of Clinical Sciences, Danderyd University Hospital, Stockholm, Sweden
| | - Mårten Rosenqvist
- Karolinska Institutet, Division of Cardiovascular Medicine, Department of Clinical Sciences, Danderyd University Hospital, Stockholm, Sweden
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von Rose AB, Kobus K, Bohmann B, Trenner M, Wahida A, Eckstein HH, Bassermann F, von Heckel K, Wolk S, Reeps C, Schwaiger BJ, Eilenberg WH, Neumayer C, Burghuber C, Busch A. Concomitantly discovered visceral artery aneurysms do rarely grow during cancer therapy. Clin Anat 2021; 35:296-304. [PMID: 34837270 DOI: 10.1002/ca.23813] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Revised: 11/16/2021] [Accepted: 11/21/2021] [Indexed: 01/21/2023]
Abstract
Visceral artery aneurysms (VAA) are a rare entity of arterial aneurysms with the imminent threat of rupture. The impact of cancer and chemotherapy on the growth of VAAs is unknown. A retrospective dual center cohort study of patients with concomitant VAA and different types of cancer was conducted and the impact of various chemotherapeutic agents on VAA growth was studied by sequential CT analysis. For comparison, a non-cancer all comer cohort with VAAs and no cancer was studied to compare different growth rates. The primary endpoint was aneurysm progress or regression >1.75 mm. Chi-square test, Fisher's exact test and Mann-Whitney test was used for statistical comparison. In the 17-year-period from January 2003 to March 2020, 59 patients with 30 splenic artery aneurysms, 14 celiac trunk aneurysms, 11 renal artery aneurysms and 4 other VAA and additional malignancy were identified. 20% of patients suffered from prostate cancer, the rest were heterogeneous. The most prevalent chemotherapies were alkylating agents (23%), antimetabolites (14%) and mitose inhibitors (10%). Eight patients had relevant growth of their VAA and one patient showed diameter regression (average growth rate 0.1 ± 0.5 mm/year). Twenty-nine patients with 14 splenic, 11 RAAs (seven right) and 4 celiac trunk aneurysms were available in the non-cancer comparison cohort (average growth rate 0.5 ± 0.9 mm/year, p = 0.058). However, the growth rate of patients receiving operative treatment for relevant VAA growth was significantly higher (p = 0.004). VAAs grow rarely, and rather slow. Cancer and/or chemotherapy do not significantly influence the annual growth rate. Additional control examinations seem unnecessary.
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Affiliation(s)
- Aaron Becker von Rose
- III. Medical Department for Hematology and Oncology, Klinikum rechts der Isar Technical University Munich, Munich, Germany
| | - Kathrin Kobus
- Department for Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Bianca Bohmann
- Department for Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Matthias Trenner
- Department for Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Adam Wahida
- III. Medical Department for Hematology and Oncology, Klinikum rechts der Isar Technical University Munich, Munich, Germany
| | - Hans-Henning Eckstein
- Department for Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Florian Bassermann
- III. Medical Department for Hematology and Oncology, Klinikum rechts der Isar Technical University Munich, Munich, Germany
| | | | - Steffen Wolk
- Division of Vascular and Endovascular Surgery, Department for Visceral, Thoracic and Vascular Surgery, Medical Faculty Carl Gustav Carus and University Hospital, Technische Universität Dresden, Dresden, Germany
| | - Christian Reeps
- Division of Vascular and Endovascular Surgery, Department for Visceral, Thoracic and Vascular Surgery, Medical Faculty Carl Gustav Carus and University Hospital, Technische Universität Dresden, Dresden, Germany
| | - Benedikt J Schwaiger
- Department of Radiology and Department of Neuroradiology, School of Medicine, Technical University of Munich, Munich, Germany
| | - Wolf-Hans Eilenberg
- Division of Vascular Surgery and Surgical Research Laboratories, Department of Surgery, Medical University of Vienna, General Hospital of Vienna, Vienna, Austria
| | - Christoph Neumayer
- Division of Vascular Surgery and Surgical Research Laboratories, Department of Surgery, Medical University of Vienna, General Hospital of Vienna, Vienna, Austria
| | - Christoph Burghuber
- Division of Vascular Surgery and Surgical Research Laboratories, Department of Surgery, Medical University of Vienna, General Hospital of Vienna, Vienna, Austria
| | - Albert Busch
- Department for Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University Munich, Munich, Germany.,Division of Vascular and Endovascular Surgery, Department for Visceral, Thoracic and Vascular Surgery, Medical Faculty Carl Gustav Carus and University Hospital, Technische Universität Dresden, Dresden, Germany
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10
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Jergovic I, Cheesman MA, Siika A, Khashram M, Paris SM, Roy J, Hultgren R. Natural history, growth rates, and treatment of popliteal artery aneurysms. J Vasc Surg 2021; 75:205-212.e3. [PMID: 34500029 DOI: 10.1016/j.jvs.2021.07.243] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 07/30/2021] [Indexed: 11/15/2022]
Abstract
BACKGROUND The natural history of a cohort of patients monitored for popliteal artery aneurysms (PAAs) has not been well described. A prevailing uncertainty exists regarding the optimal surveillance strategies and timing of treatment. The primary aim of the present study was to describe the care trajectory of all patients with PAAs identified at two tertiary vascular centers, both in surveillance and eventually treated. The secondary aim was to define the PAA growth rates. METHODS A retrospective, multicenter cohort study was performed of all patients with PAAs at two vascular centers in two countries (Sweden, 2009-2016; New Zealand, 2009-2017). Data were collected from electronic medical records regarding the comorbidities, treatment, and outcomes and analyzed on a patient- and extremity-specific level. Treatment was indicated at the occurrence of emergent symptoms or considered at a PAA threshold of >2 cm. The PAAs were divided into small (≤15 mm) and large (>15 mm) aneurysms. The mean surveillance follow-up was 5.1 years. RESULTS Most of the 241 identified patients (397 limbs) with a diagnosis of PAAs had bilateral aneurysms (n = 156). Most patients were treated within the study period (163 of 241; 68%), and one half of the diagnosed extremities with PAA had been treated (54%; 215 of 397). Among those who had undergone elective repair, treatment had usually occurred within 1 year after the diagnosis (66%; 105 of 158). More small PAAs were detected in the group that had required emergent repair compared with elective repair (6 of 57 [11%] vs 12 of 158 [8%]; P < .001). No differences were found in the mean diameters between the elective and emergent groups (30.1 mm vs 32.2 mm; P = .39). Growth was recorded in 110 PAAs and on multivariate analysis was associated with a larger index diameter (odds ratio, 1.138; 95% confidence interval, 1.040-1.246; P = .005) and a concurrent abdominal aortic aneurysm (odds ratio, 2.553; 95% confidence interval, 1.018-6.402; P = .046). CONCLUSIONS The present cohort of patients represented a true contemporary clinical setting of monitored PAAs and showed that most of these patients will require elective repair, usually within 1 year. The risk of emergent repair is not negligible for patients with smaller diameter PAAs. However, the optimal selection strategy for preventive early repair is still unknown. Future morphologic studies are needed to support the development of individualized surveillance protocols.
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Affiliation(s)
- Iva Jergovic
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; Department of Vascular Surgery, Karolinska University Hospital, Stockholm, Sweden.
| | - Magnus A Cheesman
- Department of Vascular Surgery, Waikato Hospital, Hamilton, New Zealand
| | - Antti Siika
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Manar Khashram
- Department of Vascular Surgery, Waikato Hospital, Hamilton, New Zealand; Department of Surgery, University of Auckland, New Zealand
| | - Simon M Paris
- Department of Vascular Surgery, Waikato Hospital, Hamilton, New Zealand
| | - Joy Roy
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; Department of Vascular Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - Rebecka Hultgren
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; Department of Vascular Surgery, Karolinska University Hospital, Stockholm, Sweden
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11
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Effect of Doxycycline on Survival in Abdominal Aortic Aneurysms in a Mouse Model. CONTRAST MEDIA & MOLECULAR IMAGING 2021; 2021:9999847. [PMID: 34007253 PMCID: PMC8099506 DOI: 10.1155/2021/9999847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 04/12/2021] [Accepted: 04/19/2021] [Indexed: 11/18/2022]
Abstract
Background Currently, there is no reliable nonsurgical treatment for abdominal aortic aneurysm (AAA). This study, therefore, investigates if doxycycline reduces AAA growth and the number of rupture-related deaths in a murine ApoE-/- model of AAA and whether gadofosveset trisodium-based MRI differs between animals with and without doxycycline treatment. Methods Nine ApoE-/- mice were implanted with osmotic minipumps continuously releasing angiotensin II and treated with doxycycline (30 mg/kg/d) in parallel. After four weeks, MRI was performed at 3T with a clinical dose of the albumin-binding probe gadofosveset (0.03 mmol/kg). Results were compared with previously published wild-type control animals and with previously studied ApoE-/- animals without doxycycline treatment. Differences in mortality were also investigated between these groups. Results In a previous study, we found that approximately 25% of angiotensin II-infused ApoE-/- mice died, whereas in the present study, only one out of 9 angiotensin II-infused and doxycycline-treated ApoE-/- mice (11.1%) died within 4 weeks. Furthermore, doxycycline-treated ApoE-/- mice showed significantly lower contrast-to-noise (CNR) values (p=0.017) in MRI compared to ApoE-/- mice without doxycycline treatment. In vivo measurements of relative signal enhancement (CNR) correlated significantly with ex vivo measurements of albumin staining (R 2 = 0.58). In addition, a strong visual colocalization of albumin-positive areas in the fluorescence albumin staining with gadolinium distribution in LA-ICP-MS was shown. However, no significant difference in aneurysm size was observed after doxycycline treatment. Conclusion The present experimental in vivo study suggests that doxycycline treatment may reduce rupture-related deaths in AAA by slowing endothelial damage without reversing aneurysm growth.
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12
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Bains P, Oliffe JL, Mackay MH, Kelly MT. Screening Older Adult Men for Abdominal Aortic Aneurysm: A Scoping Review. Am J Mens Health 2021; 15:15579883211001204. [PMID: 33724072 PMCID: PMC7970195 DOI: 10.1177/15579883211001204] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 01/28/2021] [Accepted: 02/10/2021] [Indexed: 11/25/2022] Open
Abstract
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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Affiliation(s)
- Priya Bains
- School of Nursing, University of
British Columbia, Vancouver, BC, Canada
| | - John L. Oliffe
- School of Nursing, University of
British Columbia, Vancouver, BC, Canada
- Department of Nursing, University
of Melbourne, Melbourne, VIC, Australia
| | - Martha H. Mackay
- School of Nursing, University of
British Columbia, Vancouver, BC, Canada
- Centre for Health Evaluation and
Outcomes Sciences, Vancouver, BC, Canada
| | - Mary T. Kelly
- School of Nursing, University of
British Columbia, Vancouver, BC, Canada
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13
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Paraskevas KI, Zeebregts CJ, Veith FJ. Debating the Usefulness of Abdominal Aortic Aneurysm Screening Programs: A Never-Ending Story. Angiology 2020; 72:392-393. [PMID: 32929982 DOI: 10.1177/0003319720958336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Kosmas I Paraskevas
- Department of General and Vascular Surgery, Central Clinic of Athens, Athens, Greece
| | - Clark J Zeebregts
- Division of Vascular Surgery, Department of Surgery, University Medical Center Groningen, University of Groningen, The Netherlands
| | - Frank J Veith
- Division of Vascular Surgery, New York University Langone Medical Center, NY, USA.,Division of Vascular Surgery, The Cleveland Clinic, OH, USA
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