Modelling the impact of changes to abdominal aortic aneurysm screening and treatment services in England during the COVID-19 pandemic.
Modelling the impact of changes to abdominal aortic aneurysm screening and treatment services in England during the COVID-19 pandemic.
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DOI：
10.1371/journal.pone.0253327
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发表时间：
2021
期刊：
影响因子：
3.7
通讯作者：
Harrison SC
中科院分区：
文献类型：
--
作者：
Kim LG;Sweeting MJ;Armer M;Jacomelli J;Nasim A;Harrison SC
英国国民健康服务(NHS)腹主动脉瘤(AAA)筛查计划(NAAASP)对65岁的男性进行筛查。该计划监测那些患有动脉瘤的人，对大型动脉瘤的早期干预减少了破裂和与AAA相关的死亡率。在新冠肺炎之后，腹主动脉瘤筛查服务被中断，但尚不清楚这可能如何影响腹主动脉瘤相关死亡率，也不知道随着服务恢复，应将努力集中在哪里。我们重新调整了先前验证的离散事件模拟模型的用途，以调查新冠肺炎相关服务中断对关键结果的影响。这一模型被用来探索延迟邀请和减少应邀参加筛查的男性的影响。此外，我们使用NAAASP的数据，调查了暂时暂停扫描、将择期手术门槛提高到7厘米以及在接受监测的AAA队列中增加辍学的影响。初次筛查的邀请推迟两年对关键结果几乎没有影响，而出席人数减少10%可能导致终生AAA相关死亡增加2%。在监测患者中，暂停监测一年或提高选择性阈值导致与AAA相关的死亡增加0.4%(开始时5-5.4 cm的死亡增加8%)。更长时间的停职或退出监测的人数增加一倍，将对结果产生显著影响。应努力鼓励男性参加新冠肺炎后的AAA筛查服务预约。随着筛查计划的恢复，那些接受AAA监测的人应该优先考虑，因为这些服务的变化超过一年可能会对手术负担和AAA相关死亡率产生更大的影响。
The National Health Service (NHS) abdominal aortic aneurysm (AAA) screening programme (NAAASP) in England screens 65-year-old men. The programme monitors those with an aneurysm, and early intervention for large aneurysms reduces ruptures and AAA-related mortality. AAA screening services have been disrupted following COVID-19 but it is not known how this may impact AAA-related mortality, or where efforts should be focussed as services resume. We repurposed a previously validated discrete event simulation model to investigate the impact of COVID-19-related service disruption on key outcomes. This model was used to explore the impact of delayed invitation and reduced attendance in men invited to screening. Additionally, we investigated the impact of temporarily suspending scans, increasing the threshold for elective surgery to 7cm and increasing drop-out in the AAA cohort under surveillance, using data from NAAASP to inform the population. Delaying invitation to primary screening up to two years had little impact on key outcomes whereas a 10% reduction in attendance could lead to a 2% lifetime increase in AAA-related deaths. In surveillance patients, a 1-year suspension of surveillance or increase in the elective threshold resulted in a 0.4% increase in excess AAA-related deaths (8% in those 5–5.4cm at the start). Longer suspensions or a doubling of drop-out from surveillance would have a pronounced impact on outcomes. Efforts should be directed towards encouraging men to attend AAA screening service appointments post-COVID-19. Those with AAAs on surveillance should be prioritised as the screening programme resumes, as changes to these services beyond one year are likely to have a larger impact on surgical burden and AAA-related mortality.
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影响因子：
2.9
作者：
Jacomelli, Jo;Summers, Lisa;Earnshaw, Jonothan J.
通讯作者：
Earnshaw, Jonothan J.
影响因子：
3.6
作者：
Glover, Matthew J.;Jones, Edmund;Thompson, Simon G.
通讯作者：
Thompson, Simon G.
监测 COVID-19 大流行对英国心血管疾病服务的间接影响。
DOI：
10.1136/heartjnl-2020-317870
发表时间：
2020-12
期刊：
Heart (British Cardiac Society)
影响因子：
--
作者：
Ball S;Banerjee A;Berry C;Boyle JR;Bray B;Bradlow W;Chaudhry A;Crawley R;Danesh J;Denniston A;Falter F;Figueroa JD;Hall C;Hemingway H;Jefferson E;Johnson T;King G;Lee KK;McKean P;Mason S;Mills NL;Pearson E;Pirmohamed M;Poon MTC;Priedon R;Shah A;Sofat R;Sterne JAC;Strachan FE;Sudlow CLM;Szarka Z;Whiteley W;Wyatt M;CVD-COVID-UK Consortium
通讯作者：
CVD-COVID-UK Consortium
影响因子：
9.6
作者：
Glover, M. J.;Kim, L. G.;Buxton, M. J.
通讯作者：
Buxton, M. J.
影响因子：
3.6
作者：
Thompson, Simon G.;Bown, Matthew J.;Sweeting, Michael J.
通讯作者：
Sweeting, Michael J.