Abdominal Aortic Aneurysm Ultrasound Screening Programme

Abdominal Aortic Aneurysm Ultrasound Screening Programme Susmi Suresh Role of the National Abdominal Aortic Aneurysm Ultrasound Screening Programme in Improving Health Outcomes: a systematic review Abstract Background: Abdominal Aortic Aneurysm (AAA) is one of the common conditions that affect men aged 65 and older. Described as a ‘ticking bomb’ (1) , rupture of such an aneurysm results in fatal bleeding and death. Early detection allows appropriate treatment to be given to patients as an effort to reduce mortality rates. The National Abdominal Aortic Aneurysm Screening programme, an initiative of Public Health England, offers screening to men in the prevalence group by following its objective of reducing mortality rates of preventable illnesses (2) . Ultrasonography is the chosen imaging modality due to its high sensitivity and specificity (3) . The aim of this study is to examine current literature on AAA and to understand whether screening programmes are effective enough to reduce mortality rates of AAA. Quality of life (QoL) as a health outcome will also be examined and evidence analysed, to see whether screening programmes affect patients’ quality of life. Method: A thorough search of prominent databases was carried out and the search-results underwent application of inclusion and exclusion criteria developed for this review. Four major randomised controlled trials were identified. Following data extraction, quality assessment was carried out using the CASP tool. Risk of bias was checked using the Cochrane’s tool for assessing risk of bias. All of these ensured a valid conclusion to be drawn.   Results: The four chosen RCTs were the MASS trial, the Chichester trial, the Viborg trial and the WA trial. The Mass and Chichester trials were conducted in the UK whereas the Viborg and WA trials were carried out in Denmark and Australia, respectively. The data pool of 125595 people added to the reliability of the findings of this review. A significant reduction in mortality rates of AA A was found in the intervention groups following an ultrasound screening of the abdominal aorta (4-7) . QoL was looked at as the secondary outcome in the MASS trial which concluded that there was no adverse effect on QoL (4) . Conclusion: The review showed evidence on reduced AAA mortality rates in men aged 65 and older following ultrasound screening. No adverse effect in patients’ QoL was found. The NAAASP is a commendable initiative of Public Health England and it is suggested that similar screening programmes be introduced through an evidence-based healthcare. Introduction       An aneurysm forms when a section of a weakened arterial wall dilates permanently. The walls of an artery can weaken and dilate due to cardiovascular diseases like arteriosclerosis, inflammation of the arterial wall or trauma. When this dilation occurs in the abdominal aorta, which runs from T12 to L5, it is considered to be an Abdominal Aortic Aneurysm (AAA)(8). Several studies have found smo king, hypertension and alcohol consumption to be the major risk factors of AAA(9). A family history of AAA is also considered to be a risk factor(10). AAA is age and sex-dependent as concluded by a retrospective prevalence study that looked at a cohort of 100,000 men and women each. The prevalence among men was found to increase rapidly after the age of 55 and that among women increases after the age of 70(11). Therefore, women are considered to be at low risk of developing AAA and hence screening programmes focus on a male population of 65 years or older(12).