Screening Older Men for Abdominal Aortic Aneurysm

Nov 02, 2016
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Authors:
McCaul KA, Lawrence-Brown M, Dickinson JA, et al.
Citation:
Long-Term Outcomes of the Western Australian Trial of Screening for Abdominal Aortic Aneurysm: Secondary Analysis of a Randomized Clinical Trial. JAMA Intern Med 2016;Oct 31:[Epub ahead of print].
Summary By:
Prashant Vaishnava, MD, FACC

Study Questions:

Does screening for abdominal aortic aneurysms (AAAs) in men aged 64-83 years reduce mortality from AAAs in the long term?

Methods:

This was a randomized clinical trial performed from 1996 through 1999 with a mean of 12.8 years of follow-up and included a population-based sample from Western Australia. Patients were randomized to ultrasonography of the abdominal aorta or a control group without invitation. The main outcome was surgery for and mortality from AAA.

Results:

There were 19,249 men in the invited group and 19,231 men in the control group. Overall, there were 90 deaths from AAAs in the invited group (mortality rate, 47.86 per 100,000 person-years; 95% confidence interval [CI], 38.93-58.84) and 98 in the control group (52.53 per 100,000 person-years; 95% CI, 48.09-64.03) for a rate ratio of 0.91 (95% CI, 0.68-1.21).

Conclusions:

In this randomized clinical trial conducted in Western Australia, screening men aged 64-83 years for AAA did not result in a significant reduction in mortality from AAA after nearly 13 years of follow-up.

Perspective:

As the authors suggest based on their results, ‘A national screening program using administrative databases...to identify men aged 64 to 83 years or 65 to 74 years is unlikely to be effective.’ Selective screening of high-risk subsets may be more effective, in addition to such interventions as smoking cessation, blood pressure control, and lipid management.

Keywords: Aorta, Abdominal, Aortic Aneurysm, Abdominal, Blood Pressure, Cardiac Surgical Procedures, Diagnostic Imaging, Geriatrics, Primary Prevention, Risk Reduction Behavior, Smoking Cessation, Ultrasonography, Vascular Diseases


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