Your New Year’s “resolution”—check your “screen!”

Abstract

Ho et al 1 Ho V.T. Tran K. George E.L. Asch S.M. Chen J.H. Dalman R.L. et al. Most privately insured patients do not receive federally recommended abdominal aortic screening. J Vasc Surg. 2023; 77: 1669-1673 Google Scholar provide modern data benchmarking the penetrance of abdominal aortic aneurysm (AAA) screening among a large retrospective cohort of the United States’ insured population via the IBM Marketscan Research Databases. Herein, the authors highlight suboptimal guideline adherence to AAA screening, especially in rural populations. While highlighting the deficiencies of current AAA screening, the limitations of the authors’ work pose more exciting questions: (1) How many lives are saved by AAA screening in modern cohorts? Prior authors 2 Oliver-Williams C. Sweeting M.J. Jacomelli J. Summer L. Stevenson A. Lees T. et al. Safety of men with small and medium abdominal aortic aneurysms under surveillance in the NAAASP. Circulation. 2019; 139: 1371-1380 Crossref PubMed Scopus (40) Google Scholar have shown that AAA discovered during screening may grow/rupture at a slower rate than described in the surveillance arms of randomized controlled trials studying small AAA. There remains a gap in the literature to externally validate the lower growth, rupture, and mortality rates from AAA found during screening. Furthermore, scant literature describes why there is a lower growth and rupture rate with AAAs discovered during screening. Ho et al 1 Ho V.T. Tran K. George E.L. Asch S.M. Chen J.H. Dalman R.L. et al. Most privately insured patients do not receive federally recommended abdominal aortic screening. J Vasc Surg. 2023; 77: 1669-1673 Google Scholar could not associate death with AAA screening. (2) Who is not getting screened properly, and why? Prior literature has described differential outcomes based on race and socioeconomic status with respect to AAA outcomes and screening. Overcoming disparities requires identification and quantification of the scope and impact of the disparities so that health care providers and systems can target research and, eventually, interventions to iteratively improve access to AAA screening. The IBM Marketscan Research Databases lack the granularity to ascertain data regarding race and ethnicity, and many socioeconomic variables. (3) Does AAA screening benefit females? According to the Centers for Disease Control, women comprise 39% of AAA-related deaths in people aged ≥65 years in the United States between 2018 and 2021. 3 Centers for Disease Control and Prevention, National Center for Health Statistics National Vital Statistics SystemMortality 2018-2021 on CDC WONDER online database, released in 2021. Data are from the multiple case of death files, 2018-2021, as compiled from data provided by the 57 vital statistics jurisdictions through the Vital Statistics Cooperative Program. http://wonder.cdc.gov/ucd-icd10-expanded.htmlDate accessed: January 27, 2023 Google Scholar The most recent Society for Vascular Surgery guidelines 4 Chaikof E.L. Dalman R.L. Eskandari M.K. Patel M.S. Schermerhorn M.L. Starnes B.W. et al. The Society for Vascular Surgery practice guidelines on the care of patients with an abdominal aortic aneurysm. J Vasc Surg. 2018; 67: 2-77.e2 Abstract Full Text Full Text PDF PubMed Scopus (1238) Google Scholar recommend ultrasound screening for AAAs in males and females between 65 and 75 years of age with a history of tobacco abuse. This recommendation departs from the United States Preventative Services Task Force, 5 Owens D.K. Davidson K.W. Krist A.H. Barry M.J. Cabana M. et al. US Preventive Services Task ForceScreening for abdominal aortic aneurysm: US Preventative Services Task Force recommendation statement. JAMA. 2019; 322: 2211-2218 Crossref PubMed Scopus (0) Google Scholar the European Society for Vascular Surgery, 6 Wanhainen A. Verzini F. Van Herzeele I. Allaire E. Bown M. Cohnert T. et al. Editor’s choice—European Society for Vascular Surgery (ESVS) 2019 clinical practice guidelines on the management of abdominal aorto-iliac artery aneurysms. Eur J Vasc Endovasc Surg. 2019; 57: 8-93 Abstract Full Text Full Text PDF PubMed Scopus (1271) Google Scholar and American Heart Association guidelines. 7 Isselbacher E.M. Preventza O. Black J.H. Augustides J.G. Beck A.W. Bolen M.A. et al. 2022 ACC/AHA guideline for the diagnosis and management of aortic disease: a report of the American Heart Association/American College of Cardiology Joint Committee on clinical practice guidelines. Circulation. 2022; 146: e334-e482 Crossref PubMed Scopus (43) Google Scholar The authors adhered to the United States Preventative Services Task Force guidelines and did not study the impact of AAA screening in women. Because disagreement exists among guideline writers, and because females represent a large fraction of deaths from AAA, it seems reasonable to continue to stratify data by sex to further describe the impact of ultrasound screening in females. Although analyses from large databases may only be descriptive, their conclusions remain important for hypothesis generation, forming preliminary data for grant funding, external validation, and modern updating of prior, historical results. This is particularly true for women, who have been and remain under-represented in clinical studies for vascular conditions. 8 Mayor J.M. Preventza O. McGinigle K. Mills J.L. Montero-Baker M. Gilani R. et al. Persistent under-representation of female patients in United States trials of common vascular diseases from 2008 to 2020. J Vasc Surg. 2022; 75: 30-36 Abstract Full Text Full Text PDF PubMed Scopus (12) Google Scholar Most privately insured patients do not receive federally recommended abdominal aortic aneurysm screeningJournal of Vascular SurgeryVol. 77Issue 6PreviewSince 2005, the United States Preventative Services Task Force has recommended abdominal aortic aneurysm (AAA) ultrasound screening for 65- to 75-year-old male ever-smokers. Integrated health systems such as Kaiser Permanente and the Veterans Affairs (VA) health care system report 74% to 79% adherence, but compliance rates in the private sector are unknown. Full-Text PDF