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AAA screening could improve outcomes for elderly men
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A systematic review of past trials determined that one-time screening for abdominal aortic aneurysm by ultrasonography among men aged at least 65 years was associated with decreased abdominal aortic aneurysm-related mortality and rupture.
“In 2005, the US Preventive Services Task Force (USPSTF) found good evidence to recommend one-time screening for [abdominal aortic aneurysm] by ultrasonography in men aged 65 to 75 years who have ever smoked. The USPSTF concluded that the benefits of screening did not clearly outweigh the harms and did not make a general recommendation for or against screening for [abdominal aortic aneurysm] in men aged 65 to 75 years who have never smoked. The USPSTF recommended against routine screening for [abdominal aortic aneurysm] in women,” researchers wrote.
The systematic review included new literature and research to provide updated evidence on the effectiveness of one-time and repeated ultrasound screening for abdominal aortic aneurysm (AAA).
Researchers studied four population-based, randomized controlled trials covering 137,214 participants that were conducted from 2004 to 2013. These trials would not have been included in the USPSTF 2005 recommendation, according to the researchers. Three of the four trials included only men; all included only participants aged at least 64 years. In all trials, one group was invited to receive AAA screening (invited group) and the other was not (control group).
The primary outcome was AAA-specific mortality, defined as all AAA deaths and all deaths within 30 days of AAA surgical repair. The two good-quality trials showed that during follow-up as long as 13 years, the invited group had a lower risk for AAA-related mortality compared with the control group (HR=0.58; 95% CI, 0.49-0.69 and HR=0.34; 95% CI, 0.2-0.57). The two fair-quality trials showed a trend toward lower risk for AAA-related mortality in the invited group, but it was not statistically significant, Janelle M. Guirguis-Blake, MD, of the University of Washington, and colleagues found. None of the trials or a pooled analysis showed any all-cause mortality benefit associated with AAA screening.
Secondary outcomes included AAA rupture and all-cause mortality rates. The two good-quality trials revealed an association between screening invitation and lower AAA rupture rates. The review revealed no significant effect of screening on all-cause mortality rates up to 15 years.
The one trial that included women was underpowered to detect differences in health outcomes because of the low prevalence of AAA in women (1.3% vs. 7.6% for men), the researchers wrote.
Participants in the invited group were approximately twice as likely to have an AAA-related operation at 3 to 5 years compared with those in the control group, and approximately 50% more likely to have an operation at 13 to 15 years.
Guirguis-Blake and colleagues noted that only male sex, age 65 years and older, and history of smoking remained strong predictors of AAA.
Several screening methods exist, but ultrasound is the accepted standard for AAA screening because of high sensitivity (94% to 100%), high specificity (98% to 100%), low cost and lack of radiation exposure, according to the study background.
Disclosure: The researchers report no relevant financial disclosures.
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