High-risk and low-risk screening for abdominal aortic aneurysm both reduce aneurysm-related mortality. A stratified analysis from a single-centre randomised screening trial. Screening for abdominal aortic aneurysm with electronic clinical reminders. Randomized clinical trial of screening for abdominal aortic aneurysm in women Selective screening for abdominal aortic aneurysms with physical examination and ultrasound. Screening for Abdominal Aortic Aneurysm: US Preventive Services Task Force Recommendation Statement. Selective screening for abdominal aortic aneurysm. Preliminary ten year results from a randomised single centre mass screening trial for abdominal aortic aneurysm. Abdominal Aortic Aneurysm (Aaa): Cost-Effectiveness of Screening, Surveillance of Intermediate-Sized Aaa, and Management of Symptomatic Aaa The long-term benefits of a single scan for abdominal aortic aneurysm (AAA) at age 65. Fifteen‐year follow‐up of a randomized clinical trial of ultrasonographic screening for abdominal aortic aneurysms Screening for abdominal aortic aneurysm: lessons from a population-based study. A Sustained Mortality Benefit from Screening for Abdominal Aortic Aneurysm Low Quality of Life Prior to Screening for Abdominal Aortic Aneurysm: A Possible Risk Factor for Negative Mental Effects Yield of repeated screening for abdominal aortic aneurysm after a 4-year interval. Aneurysm Detection and Management Veterans Affairs Cooperative Study Investigators. [Hospital costs and benefits of screening for abdominal aortic aneurysm. Results from a randomized screening trial]. The fate of patients undergoing surveillance of small abdominal aortic aneurysms. Late results concerning feasibility and compliance from a randomized trial of ultrasonographic screening for abdominal aortic aneurysm
BACKGROUND Cardiovascular diseases and chronic obstructive pulmonary disease ( COPD ) are both associated with abdominal aortic aneurysms ( AAA ) . The aim of this study was therefore to analyse whether screening for AAA could be restricted to men with such diseases ( high risk group ) . METHODS Before the date of r and omisation of a population screening trial of 12,639 64 - 73-year-old males , all discharge diagnoses from the National Patient Registry concerning AAA-related diseases were merged with the screening results on attendance , AAA prevalence , and AAA-related mortality and overall mortality . Differences in proportions were compared by Chi square tests and differences in mortality by Cox regression analyses . RESULTS The attendance rate was 78.8 % and 6.7 % had an AAA in the high risk group compared to 75.8 % attendance ( P<0.001 ) and 2.9 % ( P<0.001 ) in the remaining population . Cumulatively , screening of only high risk men with would have required 72.9 % ( 95 % C.I. : 72.3 - 74.5 % ) fewer screening invitations , would have discovered 46.1 % ( 95 % C.I. : 38.9 - 53.4 % ) of the AAA cases diagnosed and prevented 46.7 % ( 95 % C.I. : 28.3 - 65.7 % ) of the AAA-related deaths . However , screening decreased AAA-related mortality both among men with and without known COPD or cardiovascular diseases : mortality ratio : 0.22 ( 95 % C.I. : 0.08 - 0.65 ) , P=0.006 , and 0.24 ( 95 % C.I : 0.09 - 0.63 , P=0.004 , respectively . CONCLUSION High-risk population screening would prevent less than half of AAA-related deaths . Therefore , restricting screening to such high-risk groups does not seem justified , but cost effectiveness analyses are needed to reach a firm conclusion BACKGROUND Based on r and omized , population -based screening protocol s , a single ultrasound examination reduces mortality from an abdominal aortic aneurysm ( AAA ) by facilitating elective surgical intervention before rupture . Ultrasound screening is accurate , noninvasive , inexpensive , and cost effective . By using a comprehensive electronic medical record , we inquired whether an age-prompted clinical reminder would facilitate the detection of AAA . METHODS The  AAA risk screen  was installed in May 2007 via a computerized patient record system prompt for male veterans ages 65 to 75 who ever smoked . This abbreviated ultrasound examination uses a 3.5- to 4-MHz scan head , measures anteroposterior and transverse planes , and reports the largest infrarenal aortic diameter . RESULTS Of 1437 examinations there were 73 AAAs of 3.0-cm diameter or larger ( 5.1 % ) ; 33 AAAs of 4.0-cm diameter or larger ( 2.3 % ) ; 15 AAAs of 5.0-cm diameter or larger ( 1.0 % ) ; and 11 AAAs of 5.5-cm diameter or larger ( .77 % ) . Fifty ( 68 % ) received counseling for abnormal findings . CONCLUSIONS Recognition of newly diagnosed AAA compared favorably with that of previous screening studies . Electronic clinical reminders identify undiagnosed , life-threatening AAAs before rupture . Immediate counseling is available in the vascular setting Screening for abdominal aortic aneurysm ( AAA ) is commonly restricted to men . Recent studies have indicated a possible increase in deaths due to ruptured AAA in women , and a higher rate of rupture in women than in men . The present report details results from a r and omized controlled trial that assessed the effects of screening women for AAA Abdominal aortic aneurysm ( AAA ) is an important cause of preventable death in older persons . Persistently high rupture mortality rates indicate that these deaths can be prevented only by early detection and treatment of AAA . In an effort to develop an effective and efficient program of AAA detection , we selectively screened a high-risk population . Men aged 60 to 75 years with hypertension and /or coronary artery disease were r and omly selected from a general medicine clinic and screened with physical examination and ultrasound . Eighteen previously unsuspected aneurysms , 3.6 to 5.9 cm in size ( mean , 4.4 cm ) , were detected in 201 patients , for a prevalence of 9 % ( 95 % confidence interval : 4.7 % to 13.3 % ) . The specificity and positive predictive value of ultrasound were each 100 % . Abdominal palpation detected only half of these aneurysms , but missed none in patients with an abdominal girth less than 100 cm ( n = 6 ) . This degree of sensitivity did not occur with " routine " examinations and requires that the examination be directed specifically toward AAA detection . We conclude that undiagnosed AAAs are common in this large subgroup of the clinic population , that ultrasound is an excellent screening test for AAAs , and that physical examination may be adequate for screening thin patients . We recommend that every two or three years persons over the age of 50 years undergo careful abdominal palpation aim ed at detecting AAAs , as part of the periodic health examination . We further recommend that obese older men at high risk for AAA have at least one-time screening with abdominal ultrasound , regardless of findings on physical examination Importance An abdominal aortic aneurysm ( AAA ) is typically defined as aortic enlargement with a diameter of 3.0 cm or larger . The prevalence of AAA has declined over the past 2 decades among screened men 65 years or older in various European countries . The current prevalence of AAA in the United States is unclear because of the low uptake of screening . Most AAAs are asymptomatic until they rupture . Although the risk for rupture varies greatly by aneurysm size , the associated risk for death with rupture is as high as 81 % . Objective To up date its 2014 recommendation , the USPSTF commissioned a review of the evidence on the effectiveness of 1-time and repeated screening for AAA , the associated harms of screening , and the benefits and harms of available treatments for small AAAs ( 3.0 - 5.4 cm in diameter ) identified through screening . Population This recommendation applies to asymptomatic adults 50 years or older . However , the r and omized trial evidence focuses almost entirely on men aged 65 to 75 years . Evidence Assessment Based on a review of the evidence , the USPSTF concludes with moderate certainty that screening for AAA in men aged 65 to 75 years who have ever smoked is of moderate net benefit . The USPSTF concludes with moderate certainty that screening for AAA in men aged 65 to 75 years who have never smoked is of small net benefit . The USPSTF concludes that the evidence is insufficient to determine the net benefit of screening for AAA in women aged 65 to 75 years who have ever smoked or have a family history of AAA . The USPSTF concludes with moderate certainty that the harms of screening for AAA in women aged 65 to 75 years who have never smoked and have no family history of AAA outweigh the benefits . Recommendations The USPSTF recommends 1-time screening for AAA with ultrasonography in men aged 65 to 75 years who have ever smoked . ( B recommendation ) The USPSTF recommends that clinicians selectively offer screening for AAA with ultrasonography in men aged 65 to 75 years who have never smoked rather than routinely screening all men in this group . ( C recommendation ) The USPSTF recommends against routine screening for  AAA  with ultrasonography in women who have never smoked and have no family history of AAA . ( D recommendation ) The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for AAA with ultrasonography in women aged 65 to 75 years who have ever smoked or have a family history of AAA . ( I statement ) Abdominal aortic aneurysm ( AAA ) meets the criteria as a possible target for early detection by screening or case-finding , although the effectiveness of such an intervention has not yet been demonstrated . The purpose of this study was to estimate the increase in cost-effectiveness that would result from selectively screening individuals based on their risk of AAA . Data from a hospital-based case-control study involving 78 men with AAA ( unruptured ) and 99 male controls were used to derive a risk function based on age , cigarette smoking , high blood pressure , history of heart disease , body mass index and serum high-density lipoprotein , using logistic regression analysis . For each of the control subjects ( assumed to be a representative sample of the general population of elderly men ) , the risk of AAA was estimated and multiplied by the expectation of life to give a measure of the potential benefit of screening . The proportion of the total potential benefit that would be obtained by screening only those with a given level of risk was estimated , and this was related to the proportion of the population screened . In order to obtain 80 % of the total potential benefit among men , we found that it would be necessary to examine 52 % of the elderly male population if using a risk function based on age alone ; 35 % would have to be screened if age and smoking were included ; and 17 % would require screening if all the risk factors were included . Selective screening for AAA appears to be a promising strategy , but a prospect i ve study is required to demonstrate that the predictions are valid BACKGROUND At present , several regions and countries are considering screening for abdominal aortic aneurysm ( AAA ) . However , The Chichester Aneurysms Screening Trial has reported poor long term benefit of screening for AAA . We therefore supplement previously published data with a preliminary analysis of the ten-year mortality from AAA , based upon population -based data until 2002 ( 7 years ) and incomplete hospital-based information on deaths until 2005 ( 10 years ) . METHODS AND MATERIAL In 1994 we started a r and omised screening trial of 12,639 64 - 73 year-old males ; 6,306 were controls , and 6,333 were invited to an abdominal ultrasound scan at their district hospital . Information on all deaths until 15.3.2005 was obtained from the Office of Civil Registration . Information on AAA related deaths was obtained from the national registry of Causes of Deaths from 1.4.1994 to 31.12.2001 , and supplemented with AAA deaths known to the Danish National Patient Registry until 15.3.2005 . Operations were obtained from the Danish National Vascular Registry from 1.4.1994 to 15.3.2005 . Death certificates and medical records were review ed by two independent assessors . The analyses were based on " intention to treat " from the date of r and omisation . RESULTS The attendance rate was 76.6 % and 191 ( 4.0 % ) had an AAA . The median observation time was 9.58 years . In the invited group 13 subjects were acutely operated on compared to 40 in the control group ( Risk ratio : 0.32 ( 95 % C.I. 0.17 - 0.60 , P<0.001 ) ) , and 14 died due to AAA compared to 51 in the control group ( Hazard ratio : 0.27 ( 95 % C.I. : 0.15 - 0.49 , P<0.001 ) . CONCLUSION Over ten years , screening reduced mortality from AAA by 73 % , and the frequency of emergency operations by 68 % Physicians must make decisions about screening patients for abdominal aortic aneurysms ( AAAs ) , monitoring or referring for surgery patients with AAAs of various sizes , and assessing patients with symptoms that may be related to AAAs . This review article analyzes the evidence for each scenario . The effectiveness and cost-effectiveness of screening for AAA is based on results from four r and omized controlled trials . A cost-effectiveness analysis using a Markov model showed that ultrasound screening of white men beginning at age 65 is both effective and cost-effective in preventing AAA-related death . Such screening would have a small but real impact over a 20-year period in these men . For patients with a known AAA — which is often detected incidentally — the evidence clearly suggests periodic ultrasound surveillance for those with small AAAs ( 3.0–3.9 cm in diameter ) and elective surgical repair for those with large AAAs ( = 5.5 cm ) . Two recent r and omized controlled trials have shown that early surgical repair confers no survival benefit compared with periodic surveillance for patients with intermediate-sized AAAs ( 4.0–5.5 cm in diameter ) , so those patients can also be monitored . Some centers choose to increase the frequency of monitoring to every 3 to 6 months when the AAA reaches 5.0 cm . Factors to consider in assessing symptomatic patients include the high risk of life-threatening conditions , the potential increased risk of death or poor outcome with delay in diagnosis , the limitations of ultrasound in identifying whether symptoms are due to known or suspected AAA , and the timely availability of computed tomography or other imaging tests . If available , computed tomography is preferred in patients with recent or severe symptoms , since it is better at detecting retroperitoneal hemorrhage and other complications and in providing preoperative definition of the anatomy AIM To investigate the efficacy of a single ultrasonic scan at age 65 to identify patients at risk from ruptured abdominal aortic aneurysm ( AAA ) . METHOD A total of 6058 men aged 64 - 81 were recruited to a r and omised trial , and 3000 were invited to attend a single  screening test . An additional population of 1011 men was offered screening as they reached age 65 . If a normal aorta was identified in this sub-group , further scans were offered at two-yearly intervals . Follow up and treatment of those identified as having an aortic dilatation of 3 cm or greater was undertaken . All subject groups were monitored for deaths occurring over the study period , and date and cause of death were recorded . RESULTS A total of 2212 men attended screening in the r and omised trial ; the overall compliance was 74 % , and prevalence of AAA was 7.7 % . Compliance decreased , and prevalence increased , with age . Mortality from ruptured AAA was reduced by 68 % at 5 years ( screened group compared to the age-matched control population ) , and by 42 % in the study arm ( screened and refusers ) compared with controls . The benefit persisted at ten years ( 53 % and 21 % respectively ) . Of the uncontrolled sample of 1011 men offered a scan at age 65 , 681 attended and 649 of these were found to have a normal aortic diameter ; re-screening demonstrated new aneurysm development in 4 % over ten years . The aortic diameters of the new AAAs were under 4 cm and would therefore have a low risk of rupture.1 Mortality from rupture in all those with an initially normal aortic diameter was low , at 1 case per 1000 scans over ten years . CONCLUSION Screening once for AAA at age 65 can identify the majority of AAA that are of clinical significance and can identify a large population at low risk from rupture who do not require surveillance . This policy has been effective when combined with selective treatment in reducing the risk of rupture for ten years in those who attend the screening programme Long‐term benefits of screening for abdominal aortic aneurysm ( AAA ) are uncertain . These are the final results of a r and omized controlled screening trial for AAA in men , updating those reported previously . Benefit and compliance over a median 15‐year interval were examined OBJECTIVES To test the acceptability of screening and to identify modifiable risk factors for abdominal aortic aneurysm ( AAA ) in men . DESIGN A trial of ultrasound screening for AAA in a population -based r and om sample of men aged 65 - 83 years , and a cross-sectional case-control comparison of men in the same sample . PARTICIPANTS 12,203 men who had an ultrasound examination of their abdominal aorta , and completed  a question naire covering demographic , behavioural and medical factors . MAIN OUTCOME MEASURES Prevalence of AAA , and independent associations of AAA with demographic , medical and lifestyle factors . RESULTS Invitations to screening produced a corrected response of 70.5 % . The prevalence of AAAs ( > 30 mm ) rose from 4.8 % in men aged 65 - 69 years to 10.8 % in those aged 80 - 83 years . The overall prevalence of large ( > 50 mm ) aneurysms was 0.69 % . In a multivariate logistic model Mediterranean-born men had a 40 % lower risk of AAA ( > 30 mm ) compared with men born in Australia ( odds ratio [ OR ] , 0.6 ; 95 % CI , 0.4 - 0.8 ) , while ex-smokers had a significantly increased risk of AAA ( OR , 2.3 ; 95 % CI , 1.9 - 2.8 ) , and current smokers had even higher risks . AAA was significantly associated with established coronary and peripheral arterial disease and a waist : hip ratio greater than 0.9 ; men who regularly undertook vigorous exercise had a lower risk ( OR , 0.8 ; 95 % CI , 0.7 - 1.0 ) . CONCLUSION Ultrasound screening for AAA is acceptable to men in the likely target population . AAA shares some but not all of the risk factors for occlusive vascular disease , but the scope for primary prevention of AAA in later life is limited Context Is it cost-effective to screen older adults for abdominal aortic aneurysm ( AAA ) ? Contribution This 7-year follow-up report of a large r and omized trial in the United Kingdom found that men age 65 to 74 years who were invited to have ultrasonography and surveillance for AAA  had lower mortality rates than did those who were not invited ( hazard ratio , 0.53 [ CI , 0.42 to 0.68 ] ) . Cost-effectiveness for AAA-related deaths , based on costs applied to the events experienced by the men , was estimated at $ 19500 ( CI , $ 12400 to $ 39800 ) per life-year gained . Caution s Only men were studied .  Actual costs of screening and surveillance  may vary substantially in different setting s. The Editors A fast-growing body of literature is providing evidence in favor of screening men for abdominal aortic aneurysm ( AAA ) . Several large , r and omized trials published in the past few years ( 14 ) have consistently shown that screening reduces AAA-related mortality . A few observational studies of programs under way in localized areas have established the feasibility of systematic screening and have explored its practical implementation ( 57 ) . In addition to the mortality benefit , evidence indicating that screening is highly cost-effective is increasing ( 811 ) . In light of this evidence , national screening programs are now being considered in many countries ( 1214 ) . However , there is little evidence regarding long-term outcomes after AAA screening ; almost all of the evidence from r and omized trials is limited to the first 4 years after screening ( 14 ) . Moreover , long-term cost-effectiveness has been estimated only through health economic modeling ( 10 ) . We describe cost-effectiveness based on 7-year follow-up from the largest of the 4 trials of AAA screeningthe Multicentre Aneurysm Screening Study ( MASS ) ( 2 ) . The trial r and omly assigned approximately 67800 men age 65 to 74 years to receive an invitation to screening or to not receive an invitation .  At 4-year follow-up , the trial reported a substantial relative reduction of 42 % ( 95 % CI , 22 % to 58 % ) in AAA-related mortality and an incremental cost-effectiveness ratio of $ 44900 ( CI , $ 24000 to $ 231000 ) per life-year gained ( 9 ) , which is at the borderline of the commonly accepted threshold for interventions . All values are reported in U.S. dollars ( U.K. 1 = U.S. $ 1.58 ) ( 15 ) . The costs of AAA screening are primarily incurred at the start of the program , but benefits continue to accrue in terms of life-years gained in patients in whom AAA rupture is avoided through elective surgery . It is therefore expected that cost-effectiveness of screening will improve over time . The mid-term results of MASS provide reliable , trial-based information regarding clinical outcomes and cost-effectiveness over a longer period . Methods The details of the MASS protocol were described previously ( 2 ) , but a brief summary is provided ( Figure 1 ) . Between 1997 and 1999 , a population -based sample of 70495 men age 65 to 74 years from 4 centers in the United Kingdom was identified by obtaining records for every man in this age range who was registered with a family physician ( registered persons account for approximately 98 % of the population ) . Persons who were ineligible for the trial ( incorrect details , known AAA , previous AAA surgery , or terminal illness ) were excluded before r and omization . The remaining 67770 men were r and omly assigned to receive an invitation to ultrasonography for AAA or to not receive an invitation to ultrasonography . At screening , men with an aortic diameter of 3.0 cm or greater were defined as having an AAA and were subsequently invited for recall scans to monitor growth of the aneurysm . Men with an aortic diameter of 3.0 to 4.4 cm were rescreened every year , and those with an aortic diameter of 4.5 to 5.4 cm were rescreened every 3 months . Participants were considered for elective surgery when the aortic diameter reached 5.5 cm , aortic expansion was 1.0 cm or more in 1 year , or they experienced symptoms attributable to the aneurysm . Men with an aortic diameter less than 3.0 cm on the initial scan were not rescreened . Blood pressure was also measured ; although family physicians were informed of these measurements , no further intervention was provided through the screening program . We obtained approval from local ethics committees at each center , and all patients who had screening provided signed informed consent . Figure 1 . Study flow diagram . Additional data on follow-up scans and AAA surgeries were collected from hospital records . Deaths up to 31 March 2005 were confirmed by the U.K. Office of National Statistics after matching of the unique National Health Service number for each person . Follow-up ranged from 5.9 to 8.2 years ( mean , 7.1 years ) . The primary outcome of interest , AAA-related mortality , is defined as all deaths within 30 days of any AAA surgery ( elective or emergency ) plus all deaths with International Classification of Diseases , Ninth Revision , codes 441.3 ( ruptured abdominal aortic aneurysm ) , 441.4 ( abdominal aortic aneurysm without mention of rupture ) , 441.5 ( ruptured aortic aneurysm at unspecified site ) , or 441.6 ( aortic aneurysm at unspecified site without mention of rupture ) . The use of codes 441.5 and 441.6 may result in inclusion of some thoracic aortic aneurysm deaths . Investigation of the accuracy of cause-of-death coding on the death certificates was done by an independent mortality working party that was blinded to group allocation . The results of this analysis showed that inaccuracies in coding did not have an important impact on study outcomes ( 2 ) . Statistical Analysis All analyses were done by using Stata , version 9 ( Stata Corp. , College Station , Texas ) . Deaths related to AAA ( primary analysis ) and all-cause mortality ( secondary analysis ) were compared between the 2 r and omized groups by using unadjusted Cox regression by intention-to-treat analysis . Adjustment for age at baseline did not influence the results . The proportional hazards assumption was tested by using Schoenfeld residuals . An unbiased r and omization-based estimate of the benefit of  screening  was also obtained ( 16 ) . This estimate is calculated by subtracting from the control group a subgroup that is equivalent in terms of survival to the nonadherent subgroup in the invited group . Thus , the remaining controls are comparable to the group of invited patients who attended screening . Life-years gained are estimated as the area between the KaplanMeier curves for both groups ( 17 ) . The cost-effectiveness of screening  is estimated from a health service perspective for follow-up truncated at 7 years , with adjustment for censoring ( 18 ) . Details of the costing exercise in the trial at 20002001 prices were reported previously ( 9 ) . The unit costs obtained ( U.K. 1 = U.S. $ 1.58 for the year 2000 [ 15 ] ) are inflated to the 20042005 financial-year level by using annual hospital and community health services pay and price inflation indices ( 19 ) . Costs are applied to the following events on the basis of individual re source use : invitation to screening ( $ 2.46 ) , reinvitation after nonresponse ( $ 2.42 ) , initial scan ( $ 35.95 ) , recall scan ( $ 86.74 ; done in the hospital rather than in the community and including costs for periodic routine meetings with a consultant ) , consultation for elective surgery ( $ 583.79 ) , elective AAA surgery ( $ 13015.74 ) , and emergency AAA surgery ( $ 21054.32 ) . Costs relating to scans of incidentally detected AAAs in the control group are not included ( data not available ) , but costs relating from result ant AAA repair surgery are included . Sensitivity analyses were done by using 1 ) costs retained at the 20002001 financial-year level for comparison with previous publications , 2 ) quality -adjusted life-years based on age-related reductions , 3 ) U.S.-based unit cost estimates for scans and surgeries , 4 ) an increase of 50 % in the cost of a consultation  ( a U.S.-based estimate was not available , but this analysis reflects possible additional assessment s ) , 5 ) 3 and 4 combined . Quality -of-life adjustments are made only on the basis of age , with an adjustment of 0.78 for life-years gained between the ages 65 and 74 years and an adjustment of 0.75 for life-years gained at ages older than 75 years ( 20 ) . The U.S.-specific estimates for scans ( initial and recall ) are based on Medicare reimbursement for AAA screening at $ 90.95 ( Current Procedural Terminology code G0389 ) ( 21 ) , and U.S.-specific costs for surgeries are based on previously published estimates ( 22 , 23 ) that were inflated to 2004 prices ( 24 ) : $ 18160 for elective procedures and $ 31106 for emergency procedures . Discounting is applied at the current recommended values of 3 % per annum for costs and effects ( 25 ) . Estimates of AAA-related costs and effects take into account the rate of nonAAA-related deaths across both groups over time . The Fieller method is used to calculate bounds for the CI for cost-effectiveness ( 26 , 27 ) . Role of the Funding Source This study was funded by the Medical Research Council . The funding source had no role in the design , implementation , or analysis of the study . Results Figure 1 shows the flow of participants through the trial . Numbers differ slightly from earlier publications because of identification of a few duplicate records in the data base . Of 67770 r and omly assigned men , 33883 were invited to be screened : 27204 ( 80 % ) attended and 1334 ( 4.9 % ) AAAs were identified . The mean age at r and omization was 69.2 years in both groups . Loss to follow-up because of death was 2.1 % overall ( 2.2 % in the control group and 2.1 % in the invited group ) . Loss to clinical follow-up ( nonattendance at recall scans ) was 19 % at 4 years and 24 % at 7 years . The Appendix Table shows surgeries and deaths within 30 days in each of the r and omly assigned groups . A few endovascular operations are included in these figures6 in the control group and 14 in the invited group . As expected , the total number of elective procedures is greater in the invited group than in the control group The objective of this study was to evaluate the effect on quality of life ( QOL ) of screening for abdominal aortic aneurysm ( AAA ) in a population -based AAA screening program . Twenty-four patients with screening-detected AAA and 45 controls with normal aortic diameter were studied in a prospect i ve , controlled , population -based study . Prior to and 12 months after the ultrasonography examination , all participants completed  Short-Form 36  and at 12 months , 10 AAA-specific questions were added . Comparisons were made between the two groups ( AAA patients and controls ) , within each group , and between the groups and norms for the general Swedish population in the same age interval . Our results showed that screening for AAA results in impairment of QOL among those who have the disease and who suffered a low QOL prior to screening . Among those who had an age-adjusted normal QOL prior to screening and who were found to have the disease , and among those who were found to have normal aortas , no negative effect on QOL was observed . Thus , low QOL before screening is a possible risk factor for negative mental effects of diagnosing an AAA by screening BACKGROUND Little is known about the rate at which new abdominal aortic aneurysms ( AAAs ) develop or whether screening older men for AAA , if undertaken , should be limited to once in a lifetime or repeated at intervals . METHODS A large population of veterans , aged 50 through 79 years , completed a question naire and underwent ultrasound screening for AAA . Of these , 5151 without AAA on the initial ultrasound ( defined as infrarenal aortic diameter of 3.0 cm or larger ) were selected r and omly to be invited for a second  ultrasound screening  after an interval of 4 years . Local records and national data bases were search ed to identify deaths and AAA diagnoses made during the study interval in subjects who did not attend the rescreening . RESULTS Of the 5151 subjects selected for a second screening , 598 ( 11.6 % ) had died ( none due to AAA ) , and 20 ( 0.4 % ) had an interim diagnosis of AAA . A second screening was performed on 2622 ( 50.9 % ) , of whom 58 ( 2.2 % ; 95 % confidence interval , 1.6%-2.8 % ) had new AAA . Three new AAAs were 4.0 to 4.9 cm , 10 were 3.5 to 3.9 cm , and 45 were 3.0 to 3.4 cm . Independent predictors of new AAA at the second screening included current smoker ( odds ratio , 3.09 ; 95 % confidence , 1.74 - 5.50 ) , coronary artery disease ( odds ratio , 1.81 ; 95 % confidence interval , 1.07 - 3.07 ) , and , in a separate model using a composite variable , any atherosclerosis ( odds ratio , 1.97 ; 95 % confidence interval , 1.16 - 3.35 ) . Adding the interim and rescreening diagnosis rates suggests a 4-year incidence rate of 2.6 % . Rescreening only in subjects with infrarenal aortic diameter of 2.5 cm or greater on the initial ultrasound would have missed more than two thirds of the new AAAs . CONCLUSIONS A second screening is of little practical value after 4 years , mainly because the AAAs detected are small . However , the incidence that we observed suggests that a second screening after longer intervals ( ie , more than 8 years ) may provide yields similar to those seen in initial screening and therefore warrants further study INTRODUCTION The hospital costs and benefits of screening older males for abdominal aortic aneurysms ( AAA ) are unknown . MATERIAL AND METHODS In 1994 , a  hospital-based screening trial of 12,658 65 - 73-year-old males in the County of Viborg , Denmark , was started . AAA > 5 cm were referred for surgery . The remaining AAA were offered annual control scans . Those with aortic ectasia ( def . : 2.5 - 2.9 cm ) were rescreened at 5-year intervals . AAA-operations and deaths of AAA at hospital were registered . Finally , costs of screening , surveillance , and treatment were registered . Data on causes of death outside hospitals could not be obtained . RESULTS The attendance rate was 76 % , of whom 191 ( 4.0 % ) had AAA . The average observation time was 5.13 years . 60 in the screened and 41 in the control group were operated ( P = 0.06 ) , 7 and 27 were operated as an emergency ( P < 0.001 ) , and 6 and 19 died at the hospitals due to AAA ( p = 0.009 ) . The costs per scan were 83.50 DKK , 81,400 DKK per elective operation ( 71,485 DKK after screening ) , and 117,000 DKK for an emergency operation . The costs per prevented hospital death were 67,855 DKK or approx . 7,540 DKK per life year saved ( 1 GBP = 12 DKK ) . DISCUSSION Screening older males for AAA in Denmark seems very cost-effective and reduces hospital mortality of AAA by 68 % and probably the overall AAA-specific mortality by 73 % OBJECTIVES Increasing numbers of patients with small abdominal aortic aneurysms ( AAA ) are being diagnosed . The aim of this paper is to define the fate of those patients undergoing surveillance of small AAAs .  SETTING U.K. district general hospital . METHODS A prospect i ve study has been carried out of all patients undergoing surveillance .  At the time of the first consultation the patient was assessed , a Detsky score calculated and the referral source noted . End points of the study were elective repair of the aneurysm , aneurysm rupture or death of the patient . RESULTS Details of 267 patients were analysed . The referral source was general practitioner in 39 % , patients with peripheral vascular disease in 32 % and department of urology in 21 % . None were referred from population screening . The cumulative 5-year risks of rupture , elective repair or non-AAA related deaths were 15 % , 26 % and 46 % for all patients , 4 % , 13 % and 38 % for patients initially presenting with AAA less than 4 cm diameter and 21 % , 42 % and 54 % for patients presenting with an AAA 4 - 5.5 cm diameter . All but one of 11 patients whose aneurysm ruptured were unfit or had declined elective repair . There were 56 non-AAA related deaths , the majority due to cardiovascular causes . Those patients with low Detsky scores had a 5-year survival of 62 % , those with high scores 44 % . The age/sex matched survival or a normal population at 5 years in 80 % . CONCLUSION Overall the non-AAA related mortality was greater than the risks of rupture or elective repair . It is important to bear in mind the poor prognosis of this group of patients compared with a normal population when considering elective repair of small AAAs The study was an up date at 10 years of a r and omized trial of the efficacy of  screening for abdominal aortic aneurysm ( AAA ) . The extent of benefit , feasibility and compliance were examined , and reasons why this intervention may fail a proportion of those screened were identified
Electronic reminders are a simple EMR addition that can provide evidence -based education while improving adherence rates with preventive health screening measures
Abstract : The 2014 United States Preventive Services Task Force systematic review found abdominal aortic aneurysm ( AAA ) screening decreased related mortality by close to half .
Despite the simplicity of screening , research suggests poor adherence to the recommended AAA screening guidelines .