Surveillance outcomes of small abdominal aortic aneurysms identified from a large screening program.
Surveillance outcomes of small abdominal aortic aneurysms identified from a large screening program.
复制标题
从大型筛查项目中发现的小型腹主动脉瘤的监测结果。
DOI：
10.1016/j.jvs.2015.08.059
复制
发表时间：
2016
影响因子：
4.3
通讯作者：
Lee,EugeneS
中科院分区：
文献类型：
--
作者：
Chun,KevinC;Schmidt,AshleyS;Bains,Sukhmine;Nguyen,AnthonyT;Samadzadeh,KianaM;Wilson,MachelleD;Peters,JohnH;Lee,EugeneS
对AAA筛查项目中发现的小腹主动脉瘤（AAA）患者的监测对卫生系统构成了挑战，因为需要对大量患者进行随访。本研究评估了从一个大的筛选programmes.MethodsA回顾性图表审查的所有患者筛选为小AAA（3.0-5.4厘米），从2007年至2011年的监测结果与小AAA的患者。根据主动脉直径（3.0-3.9 cm，3年; 4.0-4.4 cm，2年; 4.5-5.4 cm，1年），使用2013 RESCAN随访指南对无既往修复史的小型AAA患者进行随访。社会经济因素，可能会影响后续率和全因死亡率筛选后，包括婚姻状况，距离医院的住所，估计家庭收入，和就业残疾状态，也evaluated.ResultsA共568例（平均值±标准差，73.4 ± 7.2岁）与小AAA（3.6 ± 0.6厘米）进行了分析。患者随访率为65.1%（n = 370/568）。随访失败的原因是医生未安排扫描（n = 139; 70.2%）、扫描安排延迟（n = 36; 18.2%）、患者未出现（n = 18; 9.1%）或患者在随访前死亡（n = 5; 2.5%）。在所有患者特异性因素中，直径较小的患者不太可能获得随访扫描（P<0.001）。无超声随访扫描的患者全因死亡风险显著增高（风险比[HR]，0.369;P< .001），辅助生活（HR，0.381;P< .001），年龄较大（HR，1.04;P= .001），和较低的家庭收入（HR，0.989;P= .01）。数据表明，社会经济因素不会显着影响随访成功。因此，医生的扫描顺序可能对小型AAA患者的随访率产生最大影响。建议对小AAA患者进行随访扫描的自动排序，以提高随访率。
ObjectiveSurveillance of patients identified with small abdominal aortic aneurysm (AAA) from an AAA screening program poses a challenge for health systems because of numerous patient follow-ups. This study evaluates the surveillance outcomes of patients identified with small AAA from a large screening program.MethodsA retrospective chart review of all patients screened for small AAA (3.0-5.4 cm) from 2007 to 2011 was conducted. Patients with small AAA and no previous history of repair were tracked for follow-up using the 2013 RESCAN follow-up guidelines according to aortic diameter (3.0-3.9 cm, 3 years; 4.0-4.4 cm, 2 years; 4.5-5.4 cm, 1 year). Socioeconomic factors that may influence the follow-up rate and all-cause mortality after screening, including marital status, distance to hospital from residence, estimated household income, and employment disability status, were also evaluated.ResultsA total of 568 patients (mean ± standard deviation, 73.4 ± 7.2 years old) with small AAA (3.6 ± 0.6 cm) were analyzed. Patient follow-up rate was 65.1% (n = 370 of 568). Reasons for follow-up failure were lack of the physician's ordering a scan (n = 139; 70.2%), delayed ordering of scans (n = 36; 18.2%), patient no-show (n = 18; 9.1%), or patient death before follow-up (n = 5; 2.5%). Of all patient-specific factors, patients with smaller diameters were unlikely to achieve follow-up scans (P< .001). A significantly higher risk of all-cause mortality was found for patients with no ultrasound follow-up scan (hazard ratio [HR], 0.369;P< .001), assisted living (HR, 0.381;P< .001), older age (HR, 1.04;P= .001), and lower household incomes (HR, 0.989;P= .01).ConclusionsThe follow-up rate of patients with small AAA was poor at 65.1%. The data indicate that socioeconomic factors do not significantly affect follow-up success. Therefore, physician ordering of scans may exert the greatest influence on follow-up rates in patients with small AAA. Automatic ordering of follow-up scans for patients with small AAAs is proposed to improve follow-up rates.