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
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
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
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 / 100 000 Italy -> 18 / 100 000 Spain -> 6.7 / 100 000 Norway -> 18.3 / 100 000 Sweden -> 12.7 / 100 000 Denmark -> 16.4 / 100 000 USA -> 14.1 / 100 000
Background In Portugal the number of AAA treated was assessed by evaluation of the central healthcare administrative database: In 2010 361 AAA were treated in Portugal Portuguese population in 2010-10.570.000 inhabitants 3,42 / 100 000
Background AAA treated by 100 000 20 18 16 14 12 11.6 18 18.3 12.7 16.4 14.1 10 8 6 4 2 6.7 3.4 0 UK Italy Spain Norway Sweden Denmark USA Portugal
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
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
Objective To perform an experimental population screening in men with age 65 years
Methods Identify the population to assess Porto metropolitan area primary health care centre: Total population: 15.230 Men 65 years: 963 Exclusion criteria - Severe dementia or disability Eligible population 933 patients
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
Results Of the 933 eligeble, 715 patients participated in the study Participation rate of 76,6% AAA prevalence of 2,2%
Results HAD PREVIOUSLY HEARD ABOUT THE DISEASE? Yes No 85% had never heard about AAA
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): 301-04. Web. 2. Svensjö, S. "Abdominal Aortic Aneurysm Screening in Sweden." Gefässchirurgie 19.6 (2014): 540-44. Web. Discussion AAA prevalence UK 1 Sweden 2 1,18% 1,7% Portugal 2,1% Treatment incidence UK Sweden 11.6 12.7 Portugal 3.41
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): 301-04. Web. 2. Svensjö, S. "Abdominal Aortic Aneurysm Screening in Sweden." Gefässchirurgie 19.6 (2014): 540-44. Web. Discussion AAA prevalence UK Sweden 1,18% 1,7% Portugal 2,1% Incidence of treatment UK Sweden 11.6 12.7 Portugal 3.41
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): 301-04. Web. 2. Svensjö, S. "Abdominal Aortic Aneurysm Screening in Sweden." Gefässchirurgie 19.6 (2014): 540-44. Web. Discussion AAA prevalence UK Sweden 2 1,18% 1,7% Portugal 2,1% Incidence of treatment UK Sweden 11.6 12.7 Portugal 3.41
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
Conclusion What's next Based on these numbers, a multidisciplinary workgroup was created to develop a systematic national screening protocol
Thank you!
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