A POPULATION-BASED SYSTEMATIC SCREENING OF AAA. IMPLICATIONS IN THE COUNTRY WITH EUROPE S LOWEST TREATMENT INCIDENCE

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1 A POPULATION-BASED SYSTEMATIC SCREENING OF AAA. IMPLICATIONS IN THE COUNTRY WITH EUROPE S LOWEST TREATMENT INCIDENCE Ricardo Castro-Ferreira, Pedro Mendes, Pedro Couto, Rosa Barreira, Fabiana Peixoto, Margarida Aguiar, Marina Neto, Dalila Rolim, José Pinto, Alberto Freitas, Paulo Gonçalves Dias, Sérgio Moreira Sampaio, Adelino Leite-Moreira, Armando Mansilha, José Fernando Teixeira

2 Disclosure Speaker name: Ricardo Castro Ferreira I have the following potential conflicts of interest to report: Consulting Employment in industry Stockholder of a healthcare company Owner of a healthcare company Other(s) X I do not have any potential conflict of interest

3 Background Western countries are describing similar AAA prevalence: 1.18% in UK, 1,7% in Sweden ( ) The incidence of AAA treated in each country is significantly more variable No data regarding the treatment of AAA in Portugal

4 Background In Medline, the algorithm: ["vascunet" OR "national registry" OR "Hospital discharge records database" OR "National inpatient sample" OR "Patient Register"] AND "abdominal aortic aneurysm". UK -> 11.6 / Italy -> 18 / Spain -> 6.7 / Norway -> 18.3 / Sweden -> 12.7 / Denmark -> 16.4 / USA -> 14.1 /

5 Background In Portugal the number of AAA treated was assessed by evaluation of the central healthcare administrative database: In AAA were treated in Portugal Portuguese population in inhabitants 3,42 /

Background AAA treated by 100 000 20 18 16 14 12 11.6 18 18.3 12.7 16.

6 Background AAA treated by UK Italy Spain Norway Sweden Denmark USA Portugal

7 Background The population adjusted incidence of AAA treatment in Portugal is up to 5 times lower than other western countries Assuming similar treatment criteria, these can only be justified by: Low prevalence Underdiagnosis

8 Background The population adjusted incidence of AAA treatment in Portugal is up to 5 times lower than other western countries It is imperative to know the real AAA prevalence in Portugal Assuming similar treatment criteria, these can only be justified by: An experimental Low prevalence population screening will partially address that question Underdiagnosis

9 Objective To perform an experimental population screening in men with age 65 years

10 Methods Identify the population to assess Porto metropolitan area primary health care centre: Total population: Men 65 years: 963 Exclusion criteria - Severe dementia or disability Eligible population 933 patients

11 Methods Patients were contacted by phone and registered letter Aortic ultrasound was preformed by experienced professionals Aortic diameter was measured by the leading-edge-to-leading-edge method AAA 4,5cm -> patient is referred to our vascular center AAA 3 to 4,5cm -> anual aortic doppler in primary health care

12 Results Of the 933 eligeble, 715 patients participated in the study Participation rate of 76,6% AAA prevalence of 2,2%

13 Results HAD PREVIOUSLY HEARD ABOUT THE DISEASE? Yes No 85% had never heard about AAA

14 1, Benson, Ruth A., Rebecca Poole, Shelagh Murray, Paul Moxey, and Ian M. Loftus. "Screening Results from a Large United Kingdom Abdominal Aortic Aneurysm Screening Center in the Context of Optimizing United Kingdom National Abdominal Aortic Aneurysm Screening Programme Protocols." Journal of Vascular Surgery 63.2 (2016): Web. 2. Svensjö, S. "Abdominal Aortic Aneurysm Screening in Sweden." Gefässchirurgie 19.6 (2014): Web. Discussion AAA prevalence UK 1 Sweden 2 1,18% 1,7% Portugal 2,1% Treatment incidence UK Sweden Portugal 3.41

15 1, Benson, Ruth A., Rebecca Poole, Shelagh Murray, Paul Moxey, and Ian M. Loftus. "Screening Results from a Large United Kingdom Abdominal Aortic Aneurysm Screening Center in the Context of Optimizing United Kingdom National Abdominal Aortic Aneurysm Screening Programme Protocols." Journal of Vascular Surgery 63.2 (2016): Web. 2. Svensjö, S. "Abdominal Aortic Aneurysm Screening in Sweden." Gefässchirurgie 19.6 (2014): Web. Discussion AAA prevalence UK Sweden 1,18% 1,7% Portugal 2,1% Incidence of treatment UK Sweden Portugal 3.41

16 1, Benson, Ruth A., Rebecca Poole, Shelagh Murray, Paul Moxey, and Ian M. Loftus. "Screening Results from a Large United Kingdom Abdominal Aortic Aneurysm Screening Center in the Context of Optimizing United Kingdom National Abdominal Aortic Aneurysm Screening Programme Protocols." Journal of Vascular Surgery 63.2 (2016): Web. 2. Svensjö, S. "Abdominal Aortic Aneurysm Screening in Sweden." Gefässchirurgie 19.6 (2014): Web. Discussion AAA prevalence UK Sweden 2 1,18% 1,7% Portugal 2,1% Incidence of treatment UK Sweden Portugal 3.41

17 Conclusion AAA prevalence in Portugal is similar to the internationally described...but the population adjusted incidence of AAA treatment in Portugal is dramatically inferior An important number of potentially fatal AAA remain to be diagnosed in Portugal

18 Conclusion What's next Based on these numbers, a multidisciplinary workgroup was created to develop a systematic national screening protocol

19 Thank you!

20 A POPULATION-BASED SYSTEMATIC SCREENING OF AAA. IMPLICATIONS IN THE COUNTRY WITH EUROPE S LOWEST TREATMENT INCIDENCE Ricardo Castro-Ferreira, Pedro Mendes, Pedro Couto, Rosa Barreira, Fabiana Peixoto, Margarida Aguiar, Marina Neto, Dalila Rolim, José Pinto, Alberto Freitas, Paulo Gonçalves Dias, Sérgio Moreira Sampaio, Adelino Leite-Moreira, Armando Mansilha, José Fernando Teixeira

President Dr. José Fernando Teixeira Vice - President Prof. Doutor Sérgio Sampaio

President Dr. José Fernando Teixeira Vice - President Prof. Doutor Sérgio Sampaio Secretary General Dr. Pedro Henrique Almeida Honorary Presidents Prof. Doutor Roncon de Albuquerque Prof. Doutor António