Show simple item record

dc.contributor.authorOliver-Williams, Clareen
dc.contributor.authorSweeting, Michaelen
dc.contributor.authorJacomelli, Joen
dc.contributor.authorSummers, Lisaen
dc.contributor.authorStevenson, Anneen
dc.contributor.authorLees, Timen
dc.contributor.authorEarnshaw, Jonothan Jen
dc.date.accessioned2019-01-22T00:30:15Z
dc.date.available2019-01-22T00:30:15Z
dc.date.issued2019-03en
dc.identifier.issn0009-7322
dc.identifier.urihttps://www.repository.cam.ac.uk/handle/1810/288277
dc.description.abstractAbstract Background Population screening for abdominal aortic aneurysm (AAA) has commenced in several countries, and has been shown to reduce AAA-related mortality by up to 50%. Most men who screen positive have an AAA below 5.5cm in diameter, the referral threshold for treatment, and are entered into an ultrasound surveillance programme. This study aimed to determine the risk of ruptured AAA (rAAA) in men under surveillance. Methods Men in the NHS AAA Screening Programme who initially had a small (3-4.4cm) or medium (4.5-5.4cm) AAA were followed-up. The screening programme’s database collected data on ultrasound AAA diameter measurements and dates of referral and loss to follow-up. Local screening programmes recorded adverse outcomes, including rAAA and death. Rupture and mortality rates were calculated by initial and final known AAA diameter. Results A total of 18,652 men were included (50,103 men years of surveillance). Thirty-one men had rAAA in surveillance, of whom 29 died. Some 952 men died from other causes during surveillance, mainly cardiovascular complications (26.3%) and cancer (31.2%). The overall mortality rate was 1.96% per annum, similar for men with small and medium AAA. The rAAA risk was 0.03% per annum (95% confidence interval 0.02-0.05%) for men with small AAA, and 0.28% (0.17-0.44%) for medium AAA. The rAAA risk for men with AAA just below the referral threshold (5.0 to 5.4 cm) was 0.40% (0.22-0.73%). Conclusions The risk of rAAA in surveillance is below 0.5% per annum, even just below the present referral threshold of 5.5cm and only 0.4% of men in surveillance are estimated to rupture before referral. It can be concluded that men with small and medium screen-detected AAA are safe provided they are enrolled in an intensive surveillance program, and that there is no evidence that the current referral threshold of 5.5cm should be changed. Key Words Abdominal Aortic Aneurysm; Men; Surveillance; Screening; Ultrasonography
dc.description.sponsorshipThis work was funded by the British Heart Foundation (RE/13/6/30180), and Homerton College, University of Cambridge. The NHS AAA Screening Programme, as part of Public Health England, is funded by the Department of Health.
dc.format.mediumPrinten
dc.languageengen
dc.publisherWolters Kluwer Health
dc.subjectHumansen
dc.subjectAortic Ruptureen
dc.subjectAortic Aneurysm, Abdominalen
dc.subjectDisease Progressionen
dc.subjectUltrasonographyen
dc.subjectMass Screeningen
dc.subjectPrognosisen
dc.subjectPopulation Surveillanceen
dc.subjectRisk Factorsen
dc.subjectPredictive Value of Testsen
dc.subjectSex Factorsen
dc.subjectTime Factorsen
dc.subjectAgeden
dc.subjectEnglanden
dc.subjectMaleen
dc.titleSafety of Men With Small and Medium Abdominal Aortic Aneurysms Under Surveillance in the NAAASP.en
dc.typeArticle
prism.endingPage1380
prism.issueIdentifier11en
prism.publicationDate2019en
prism.publicationNameCirculationen
prism.startingPage1371
prism.volume139en
dc.identifier.doi10.17863/CAM.35593
dcterms.dateAccepted2018-11-12en
rioxxterms.versionofrecord10.1161/circulationaha.118.036966en
rioxxterms.versionAM
rioxxterms.licenseref.urihttp://creativecommons.org/licenses/by-nc/4.0/en
rioxxterms.licenseref.startdate2019-03en
dc.contributor.orcidOliver-Williams, Clare [0000-0002-3573-2426]
dc.contributor.orcidSweeting, Michael [0000-0003-0980-8965]
dc.identifier.eissn1524-4539
rioxxterms.typeJournal Article/Reviewen
pubs.funder-project-idBritish Heart Foundation (RE/13/6/30180)
cam.orpheus.successThu Jan 30 10:53:27 GMT 2020 - Embargo updated*
rioxxterms.freetoread.startdate2019-09-30


Files in this item

Thumbnail

This item appears in the following Collection(s)

Show simple item record