Impact of Implicit Abdominal Aortic Aneurysm Screening in the Veterans Affairs Health Care System Over 10 Years
Background Abdominal aortic aneurysm (AAA) screening programs have been active in the United States since 2005, but are not the only way AAAs are detected. AAA management and outcomes have not been investigated broadly in the context of “implicit AAA screening,” whereby radiologic examinations not i...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2022-04-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.121.024571 |
| _version_ | 1797849674962436096 |
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| author | Joseph R. Leach Hui Shen Eugene Huo Thomas A. Hope Dimitrios Mitsouras Mary A. Whooley Michael D. Hope |
| author_facet | Joseph R. Leach Hui Shen Eugene Huo Thomas A. Hope Dimitrios Mitsouras Mary A. Whooley Michael D. Hope |
| author_sort | Joseph R. Leach |
| collection | DOAJ |
| description | Background Abdominal aortic aneurysm (AAA) screening programs have been active in the United States since 2005, but are not the only way AAAs are detected. AAA management and outcomes have not been investigated broadly in the context of “implicit AAA screening,” whereby radiologic examinations not intended for focused screening can identify AAAs. Methods and Results We examined the association between imaging‐based AAA screening, both explicit and implicit, and various outcomes for ≈1.6 million veterans in the Veterans Affairs health care system from 2005 to 2015. Screened‐positive, screened‐negative, and unscreened veterans were identified in the overall cohort and within a subgroup of veterans aged 65 years in 2005. The yearly composite screening rate increased over 10 years, from 11.7% to 18.3%, whereas the screened‐positive rate decreased from 7.3% to 4.9%. Only 12.9% of screening examinations were explicit AAA screening ultrasounds. The subgroup’s composite screening rate was 74% within its 10‐year eligibility window, with implicit screening accounting for 91.8% of examinations. In the 2005 subgroup, all‐cause mortality and Charlson comorbidity scores were higher for veterans who underwent screening compared with those unscreened (31.2% versus 23.1% and 0.47 versus 0.25, respectively; P<0.001). AAA rupture rates were similar between those unscreened and screened‐negative individuals. Conclusions Accounting for both explicit and implicit screening, AAA screening in the Veterans Affairs population has moderate reach. Efforts to expand explicit AAA screening are not likely to impact either all‐cause mortality or AAA rupture on the population scale as significantly as a careful accounting for and use of implicit screening data. |
| first_indexed | 2024-04-09T18:47:52Z |
| format | Article |
| id | doaj.art-fa0b0df9aead4064a93f2a3e8a36189e |
| institution | Directory Open Access Journal |
| issn | 2047-9980 |
| language | English |
| last_indexed | 2024-04-09T18:47:52Z |
| publishDate | 2022-04-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj.art-fa0b0df9aead4064a93f2a3e8a36189e2023-04-10T11:57:33ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802022-04-0111710.1161/JAHA.121.024571Impact of Implicit Abdominal Aortic Aneurysm Screening in the Veterans Affairs Health Care System Over 10 YearsJoseph R. Leach0Hui Shen1Eugene Huo2Thomas A. Hope3Dimitrios Mitsouras4Mary A. Whooley5Michael D. Hope6Department of Radiology and Biomedical Imaging University of CaliforniaSan Francisco, and San Francisco Veterans Affairs Medical Center San Francisco CASan Francisco Veterans Affairs Medical Center San Francisco CADepartment of Radiology and Biomedical Imaging University of CaliforniaSan Francisco, and San Francisco Veterans Affairs Medical Center San Francisco CADepartment of Radiology and Biomedical Imaging University of CaliforniaSan Francisco, and San Francisco Veterans Affairs Medical Center San Francisco CADepartment of Radiology and Biomedical Imaging University of CaliforniaSan Francisco, and San Francisco Veterans Affairs Medical Center San Francisco CASan Francisco Veterans Affairs Medical Center San Francisco CADepartment of Radiology and Biomedical Imaging University of CaliforniaSan Francisco, and San Francisco Veterans Affairs Medical Center San Francisco CABackground Abdominal aortic aneurysm (AAA) screening programs have been active in the United States since 2005, but are not the only way AAAs are detected. AAA management and outcomes have not been investigated broadly in the context of “implicit AAA screening,” whereby radiologic examinations not intended for focused screening can identify AAAs. Methods and Results We examined the association between imaging‐based AAA screening, both explicit and implicit, and various outcomes for ≈1.6 million veterans in the Veterans Affairs health care system from 2005 to 2015. Screened‐positive, screened‐negative, and unscreened veterans were identified in the overall cohort and within a subgroup of veterans aged 65 years in 2005. The yearly composite screening rate increased over 10 years, from 11.7% to 18.3%, whereas the screened‐positive rate decreased from 7.3% to 4.9%. Only 12.9% of screening examinations were explicit AAA screening ultrasounds. The subgroup’s composite screening rate was 74% within its 10‐year eligibility window, with implicit screening accounting for 91.8% of examinations. In the 2005 subgroup, all‐cause mortality and Charlson comorbidity scores were higher for veterans who underwent screening compared with those unscreened (31.2% versus 23.1% and 0.47 versus 0.25, respectively; P<0.001). AAA rupture rates were similar between those unscreened and screened‐negative individuals. Conclusions Accounting for both explicit and implicit screening, AAA screening in the Veterans Affairs population has moderate reach. Efforts to expand explicit AAA screening are not likely to impact either all‐cause mortality or AAA rupture on the population scale as significantly as a careful accounting for and use of implicit screening data.https://www.ahajournals.org/doi/10.1161/JAHA.121.024571abdominal aortic aneurysmimagingradiologyscreening |
| spellingShingle | Joseph R. Leach Hui Shen Eugene Huo Thomas A. Hope Dimitrios Mitsouras Mary A. Whooley Michael D. Hope Impact of Implicit Abdominal Aortic Aneurysm Screening in the Veterans Affairs Health Care System Over 10 Years Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease abdominal aortic aneurysm imaging radiology screening |
| title | Impact of Implicit Abdominal Aortic Aneurysm Screening in the Veterans Affairs Health Care System Over 10 Years |
| title_full | Impact of Implicit Abdominal Aortic Aneurysm Screening in the Veterans Affairs Health Care System Over 10 Years |
| title_fullStr | Impact of Implicit Abdominal Aortic Aneurysm Screening in the Veterans Affairs Health Care System Over 10 Years |
| title_full_unstemmed | Impact of Implicit Abdominal Aortic Aneurysm Screening in the Veterans Affairs Health Care System Over 10 Years |
| title_short | Impact of Implicit Abdominal Aortic Aneurysm Screening in the Veterans Affairs Health Care System Over 10 Years |
| title_sort | impact of implicit abdominal aortic aneurysm screening in the veterans affairs health care system over 10 years |
| topic | abdominal aortic aneurysm imaging radiology screening |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.121.024571 |
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