Guideline-based screening for abdominal aortic aneurysms is significantly underperformed and possibly impacted by medical comorbidities.

Abstract

The aim of this study was to define the level of underscreening of abdominal aortic aneurysms (AAAs) and its effect on rupture rates and elucidate if prior medical comorbidities may impact this. The TriNetX Analytics National Database was queried. The US Preventative Services Task Force (USPSTF) guidelines of male smokers aged 65 to 75 years and the Society for Vascular Surgery (SVS) guidelines of any smoker aged ≥65 years were used. Family history of AAA was not used. Three populations were defined: USPSTF eligible (male smokers 65-75 years old), SVS eligible (any smoker ≥65 years old), and SVS-only eligible (female smokers ≥65 years old, male smokers ≥75 years old). For each population, we isolated screened and unscreened individuals. Screened patients were defined as those who underwent a screening ultrasound examination during the eligible period, and unscreened patients were those who met screening eligibility but did not undergo ultrasound examination as determined by Current Procedural Terminology/Healthcare Common Procedure Coding System codes. International Classification of Diseases, 10th edition, codes were used to identify AAA and comorbidities. Data were matched by propensity score for age, race/ethnicity, and medical use (primary care visits, laboratory orders, etc). Screening rates for USPSTF-eligible, SVS-eligible, and SVS-only eligible patients were 3.98%, 2.12%, and 0.83%, respectively. Screening according to USPSTF, SVS, and SVS-only guidelines were associated with lower AAA rupture rates (odds ratio [OR], 0.416, 0.499, and 0.717, respectively; P < .05 for each). After propensity matching, a total of 109,444 patients were analyzed with 54,722 patients in each cohort (screened and unscreened). The screened cohort had higher rates of hyperlipidemia (OR, 2.17), hypertension (OR, 1.7), obesity (OR, 1.5), neoplasms (OR, 1.37), inflammatory polyarthropathies (OR, 1.31), systemic connective tissue disorder (OR, 1.25), diabetes mellitus (OR, 1.24), chronic kidney disease (OR, 1.2), peripheral vascular disease (OR, 1.07), and coronary artery disease (OR, 1.06). There were lower rates of paraplegia (OR, 0.43), hemiplegia (OR, 0.7), dementia (OR, 0.76), myocardial infarction (OR, 0.81), and heart failure (OR, 0.87) in the screened cohort. Each of these factors attained statistical significance (P ≤ .01). A small percentage of screening-eligible patients were actually screened for AAAs, less so based on SVS guidelines. Screening from each guideline was effective in decreasing rupture rates. USPSTF guideline-based screened patients had higher rates of specific medical comorbidities, whereas a prior history of other comorbidities was less prevalent in screened patients. Medical comorbidities may influence clinical decisions to obtain AAA screening.