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screening for abdominal aortic aneurysm (AAA)

Indications: 1) one time screening for men age 65-75 who have ever smoked [1,4,5,7,10,11] (USPSTF 2014) 2) selective screening for men aged 65-75 who have never smoked [11] (USPSTF) 3) evidence is insufficient to assess benefits vs harms of screening for women aged 65-75 years who have ever smoked [6] (USPSTF) 4) USPSTF recommends against routine screening for women who have never smoked [6] (2014) 5) no consensus on screening [2,3,4] (2002-2004) 6) Swedish study calls into question benefits of screening [13] Benefit/risk: 1) screening reduces mortality from AAA in men > 65 years - 352 screenings to save one life [6] - 5000 screenings to save one life [13] 2) screening is cost-effective [8] 3) screening twice in men with aortic diameters of 25-29 mm at initial screening may also be cost-effective [9] 4) no long term benefit for screening older men [12] 5) 2 unnecessary surgeries for every 1000 men screened [13] Procedure: - abdominal ultrasound (US) is screening method of choice - identify maximum diameter - palpation of the abdomen has poor reliability [1] - consider pulse palpation to screen to atrial fibrillation [1]

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abdominal aortic aneurysm (AAA) screening for atrial fibrillation

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screening

References

  1. Medical Knowledge Self Assessment Program (MKSAP) 11, 14, 15, 16, 17, 18. American College of Physicians, Philadelphia 1998, 2006, 2009, 2012, 2015, 2018.
  2. Journal Watch 24(1):6, 2004 Aston HA et al The Multicentre Aneurysm Screening Study (MASS) into the effect of abdominal aortic aneurysm screening on mortality in men: a randomised controlled trial. Lancet 360:1531, 2002 PMID: 12443589
  3. Multicentre Aneurysm Screening Group Multicentre aneurysm screening study (MASS): cost effectiveness analysis of screening for abdominal aortic aneurysms based on four year results from randomised controlled trial. BMJ 325:1135, 2002 PMID: 12433761
  4. Norman PE, Jamrozik K, Lawrence-Brown MM, Le MT, Spencer CA, Tuohy RJ, Parsons RW, Dickinson JA. Population based randomised controlled trial on impact of screening on mortality from abdominal aortic aneurysm. BMJ. 2004 Nov 27;329(7477):1259. Epub 2004 Nov 15. PMID: 15545293 http://bmj.bmjjournals.com/cgi/content/full/329/7477/1259
  5. Journal Watch 25(5):40, 2005 Fleming C, Whitlock EP, Beil TL, Lederle FA. Screening for abdominal aortic aneurysm: a best-evidence systematic review for the U.S. Preventive Services Task Force. Ann Intern Med. 2005 Feb 1;142(3):203-11. Review. PMID: 15684209 http://www.ahrq.gov/clinic/3rduspstf/aaascr/aaarev.htm - U.S. Preventive Services Task Force. Screening for abdominal aortic aneurysm: recommendation statement. Ann Intern Med. 2005 Feb 1;142(3):198-202. PMID: 15684208 http://www.ahrq.gov/clinic/3rduspstf/aaascr/aaars.htm - Summaries for patients. Screening for abdominal aortic aneurysm: recommendations from the U.S. Preventive Services Task Force. Ann Intern Med. 2005 Feb 1;142(3):I52. No abstract available. PMID: 15684202
  6. Lindholt JS, Juul S, Fasting H, Henneberg EW. Screening for abdominal aortic aneurysms: single centre randomised controlled trial. BMJ. 2005 Apr 2;330(7494):750. Epub 2005 Mar 9. PMID: 15757960 http://bmj.bmjjournals.com/cgi/content/full/330/7494/750
  7. Kim LG, P Scott RA, Ashton HA, Thompson SG; Multicentre Aneurysm Screening Study Group. A sustained mortality benefit from screening for abdominal aortic aneurysm. Ann Intern Med. 2007 May 15;146(10):699-706. Erratum in: Ann Intern Med. 2007 Aug 7;147(3):216. PMID: 17502630 - Lederle FA, Kane RL, MacDonald R, Wilt TJ. Systematic review: repair of unruptured abdominal aortic aneurysm. Ann Intern Med. 2007 May 15;146(10):735-41. Review. PMID: 17502634
  8. Sogaard R et al Cost effectiveness of abdominal aortic aneurysm screening and rescreening in men in a modern context: evaluation of a hypothetical cohort using a decision analytical model BMJ 2012;345:e4276 PMID: 22767630 http://www.bmj.com/content/345/bmj.e4276
  9. Sogaard R et al. Cost effectiveness of abdominal aortic aneurysm screening and rescreening in men in a modern context: Evaluation of a hypothetical cohort using a decision analytical model. BMJ 2012 Jul 5; 345:e4276 PMID: 22767630
  10. Thompson SG, Ashton HA, Gao L et al Screening men for abdominal aortic aneurysm: 10 year mortality and cost effectiveness results from the randomised Multicentre Aneurysm Screening Study. BMJ. 2009 Jun 24;338:b2307. doi: 10.1136/bmj.b2307. PMID: 19553269
  11. U.S. Preventive Services Task Force (USPSTF) Screening for Abdominal Aortic Aneurysm: U.S. Preventive Services Task Force Recommendation Statement. DRAFT. Summary of Recommendations and Evidence. http://www.uspreventiveservicestaskforce.org/draftrec.htm - Guirguis-Blake JM et al Ultrasonography Screening for Abdominal Aortic Aneurysms: A Systematic Evidence Review for the U.S. Preventive Services Task Force. Ann Intern Med. Published online 28 January 2014 PMID: 24473919 http://annals.org/article.aspx?articleid=1817257 - LeFevre ML on behalf of the U.S. Preventive Services Task Force Screening for Abdominal Aortic Aneurysm: U.S. Preventive Services Task Force Recommendation Statement. Ann Intern Med. Published online 24 June 2014 PMID: 24957320 http://annals.org/article.aspx?articleid=1883339 - US Preventive Services Task Force. Screening for abdominal aortic aneurysm: US Preventive Services Task Force recommendation statement. JAMA 2019 Dec 10; 322:2211. PMID: 31821437 - Guirguis-Blake JM et al. Primary care screening for abdominal aortic aneurysm: Updated evidence report and systematic review for the US Preventive Services Task Force. JAMA 2019 Dec 10; 322:2219. PMID: 31821436 - Freischlag JA. Updated guidelines on screening for abdominal aortic aneurysm. JAMA 2019 Dec 10; 322:2177. PMID: 31821419
  12. McCaul KA et al. Long-term outcomes of the Western Australian trial of screening for abdominal aortic aneurysms: Secondary analysis of a randomized clinical trial. JAMA Intern Med 2016 Oct 31; PMID: 27802493 - Lederle FA. The last (randomized) word on screening for abdominal aortic aneurysms. JAMA Intern Med 2016 Oct 31; PMID: 27802490
  13. Johansson M, Zahl PH, Siersma V et al Benefits and harms of screening men for abdominal aortic aneurysm in Sweden: a registry-based cohort study. Lancet 2018. 391(10138):2441-2447. June 16. PMID: 29916384 https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)31031-6/fulltext - Acosta S Screening men for AAA under magnification loupe in Sweden. Lancet 2018. 391(10138):2394-2395. June 16. PMID: 29916370 https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)31135-8/fulltext

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screening for cardiovascular disease