Surveillance outcomes of small abdominal aortic aneurysms identified from a large screening program
| Autor: | Ashley S. Schmidt, Eugene S. Lee, John H. Peters, Sukhmine Bains, Machelle D. Wilson, Anthony T. Nguyen, Kiana M. Samadzadeh, Kevin C. Chun |
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| Rok vydání: | 2016 |
| Předmět: |
Male
medicine.medical_specialty Time Factors 030204 cardiovascular system & hematology Risk Assessment Article 03 medical and health sciences 0302 clinical medicine Predictive Value of Tests Risk Factors Internal medicine Chart review medicine Humans Mass Screening In patient 030212 general & internal medicine Practice Patterns Physicians' Socioeconomic status Aged Retrospective Studies Ultrasonography Aged 80 and over business.industry Age Factors Prognosis medicine.disease Abdominal aortic aneurysm 3. Good health Surgery Socioeconomic Factors Marital status Female Aortic diameter Cardiology and Cardiovascular Medicine business Aortic Aneurysm Abdominal Healthcare system |
| Zdroj: | Journal of Vascular Surgery. 63:55-61 |
| ISSN: | 0741-5214 |
| DOI: | 10.1016/j.jvs.2015.08.059 |
| Popis: | Surveillance of patients identified with small abdominal aortic aneurysm (AAA) from an AAA screening program poses a challenge for health systems because of numerous patient follow-ups. This study evaluates the surveillance outcomes of patients identified with small AAA from a large screening program.A retrospective chart review of all patients screened for small AAA (3.0-5.4 cm) from 2007 to 2011 was conducted. Patients with small AAA and no previous history of repair were tracked for follow-up using the 2013 RESCAN follow-up guidelines according to aortic diameter (3.0-3.9 cm, 3 years; 4.0-4.4 cm, 2 years; 4.5-5.4 cm, 1 year). Socioeconomic factors that may influence the follow-up rate and all-cause mortality after screening, including marital status, distance to hospital from residence, estimated household income, and employment disability status, were also evaluated.A total of 568 patients (mean ± standard deviation, 73.4 ± 7.2 years old) with small AAA (3.6 ± 0.6 cm) were analyzed. Patient follow-up rate was 65.1% (n = 370 of 568). Reasons for follow-up failure were lack of the physician's ordering a scan (n = 139; 70.2%), delayed ordering of scans (n = 36; 18.2%), patient no-show (n = 18; 9.1%), or patient death before follow-up (n = 5; 2.5%). Of all patient-specific factors, patients with smaller diameters were unlikely to achieve follow-up scans (P.001). A significantly higher risk of all-cause mortality was found for patients with no ultrasound follow-up scan (hazard ratio [HR], 0.369; P.001), assisted living (HR, 0.381; P.001), older age (HR, 1.04; P = .001), and lower household incomes (HR, 0.989; P = .01).The follow-up rate of patients with small AAA was poor at 65.1%. The data indicate that socioeconomic factors do not significantly affect follow-up success. Therefore, physician ordering of scans may exert the greatest influence on follow-up rates in patients with small AAA. Automatic ordering of follow-up scans for patients with small AAAs is proposed to improve follow-up rates. |
| Databáze: | OpenAIRE |
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