Screening for Abdominal Aortic Aneurysm: US Preventive Services Task Force Recommendation Statement. Selective screening for abdominal aortic aneurysms with physical examination and ultrasound. High-risk and low-risk screening for abdominal aortic aneurysm both reduce aneurysm-related mortality. A stratified analysis from a single-centre randomised screening trial. [Preliminary results of screening for abdominal aortic aneurysm in the ounty of Viborg]. Screening for abdominal aortic aneurysms in men: a Canadian perspective using Monte Carlo-based estimates. A Sustained Mortality Benefit from Screening for Abdominal Aortic Aneurysm Hospital costs and benefits of screening for abdominal aortic aneurysms. Results from a randomised population screening trial. Abdominal Aortic Aneurysm (Aaa): Cost-Effectiveness of Screening, Surveillance of Intermediate-Sized Aaa, and Management of Symptomatic Aaa Preliminary ten year results from a randomised single centre mass screening trial for abdominal aortic aneurysm. The long-term benefits of a single scan for abdominal aortic aneurysm (AAA) at age 65. [Hospital costs and benefits of screening for abdominal aortic aneurysm. Results from a randomized screening trial]. Implications of screening for abdominal aortic aneurysms on surgical workload The potential for a selective screening strategy for abdominal aortic aneurysm Low Quality of Life Prior to Screening for Abdominal Aortic Aneurysm: A Possible Risk Factor for Negative Mental Effects Is screening for abdominal aortic aneurysm acceptable to the population? Selection and recruitment to hospital-based mass screening for abdominal aortic aneurysm. Prevalence and Associations of Abdominal Aortic Aneurysm Detected through Screening Psychological consequences of screening for abdominal aortic aneurysm and conservative treatment of small abdominal aortic aneurysms. The strange relationship between diabetes and abdominal aortic aneurysm. Randomized clinical trial of screening for abdominal aortic aneurysm in women Update on the Methods of the U.S. Preventive Services Task Force: Estimating Certainty and Magnitude of Net Benefit Screening for abdominal aortic aneurysm with electronic clinical reminders. Abdominal aortic aneurysm in 4237 screened patients: Prevalence, development and management over 6 years Mortality, Morbidity, and Costs of Ruptured and Elective Abdominal Aortic Aneurysm Repairs in Nova Scotia, Canada 

Importance An abdominal aortic aneurysm ( AAA ) is typically defined as aortic enlargement with a diameter of 3.0 cm or larger . The prevalence of AAA has declined over the past 2 decades among screened men 65 years or older in various European countries . The current prevalence of AAA in the United States is unclear because of the low uptake of screening . Most AAAs are asymptomatic until they rupture . Although the risk for rupture varies greatly by aneurysm size , the associated risk for death with rupture is as high as 81 % . Objective To up date its 2014 recommendation , the USPSTF commissioned a review of the evidence on the effectiveness of 1-time and repeated screening for AAA , the associated harms of screening , and the benefits and harms of available treatments for small AAAs ( 3.0 - 5.4 cm in diameter ) identified through screening . Population This recommendation applies to asymptomatic adults 50 years or older . However , the r and omized trial evidence focuses almost entirely on men aged 65 to 75 years . Evidence Assessment Based on a review of the evidence , the USPSTF concludes with moderate certainty that screening for AAA in men aged 65 to 75 years who have ever smoked is of moderate net benefit . The USPSTF concludes with moderate certainty that screening for AAA in men aged 65 to 75 years who have never smoked is of small net benefit . The USPSTF concludes that the evidence is insufficient to determine the net benefit of screening for AAA in women aged 65 to 75 years who have ever smoked or have a family history of AAA . The USPSTF concludes with moderate certainty that the harms of screening for AAA in women aged 65 to 75 years who have never smoked and have no family history of AAA outweigh the benefits . Recommendations The USPSTF recommends 1-time screening for AAA with ultrasonography in men aged 65 to 75 years who have ever smoked . ( B recommendation ) The USPSTF recommends that clinicians selectively offer screening for AAA with ultrasonography in men aged 65 to 75 years who have never smoked rather than routinely screening all men in this group . ( C recommendation ) The USPSTF recommends against routine screening for  AAA  with ultrasonography in women who have never smoked and have no family history of AAA . ( D recommendation ) The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for AAA with ultrasonography in women aged 65 to 75 years who have ever smoked or have a family history of AAA . ( I statement ) Abdominal aortic aneurysm ( AAA ) is an important cause of preventable death in older persons . Persistently high rupture mortality rates indicate that these deaths can be prevented only by early detection and treatment of AAA . In an effort to develop an effective and efficient program of AAA detection , we selectively screened a high-risk population . Men aged 60 to 75 years with hypertension and /or coronary artery disease were r and omly selected from a general medicine clinic and screened with physical examination and ultrasound . Eighteen previously unsuspected aneurysms , 3.6 to 5.9 cm in size ( mean , 4.4 cm ) , were detected in 201 patients , for a prevalence of 9 % ( 95 % confidence interval : 4.7 % to 13.3 % ) . The specificity and positive predictive value of ultrasound were each 100 % . Abdominal palpation detected only half of these aneurysms , but missed none in patients with an abdominal girth less than 100 cm ( n = 6 ) . This degree of sensitivity did not occur with " routine " examinations and requires that the examination be directed specifically toward AAA detection . We conclude that undiagnosed AAAs are common in this large subgroup of the clinic population , that ultrasound is an excellent screening test for AAAs , and that physical examination may be adequate for screening thin patients . We recommend that every two or three years persons over the age of 50 years undergo careful abdominal palpation aim ed at detecting AAAs , as part of the periodic health examination . We further recommend that obese older men at high risk for AAA have at least one-time screening with abdominal ultrasound , regardless of findings on physical examination BACKGROUND Cardiovascular diseases and chronic obstructive pulmonary disease ( COPD ) are both associated with abdominal aortic aneurysms ( AAA ) . The aim of this study was therefore to analyse whether screening for AAA could be restricted to men with such diseases ( high risk group ) . METHODS Before the date of r and omisation of a population screening trial of 12,639 64 - 73-year-old males , all discharge diagnoses from the National Patient Registry concerning AAA-related diseases were merged with the screening results on attendance , AAA prevalence , and AAA-related mortality and overall mortality . Differences in proportions were compared by Chi square tests and differences in mortality by Cox regression analyses . RESULTS The attendance rate was 78.8 % and 6.7 % had an AAA in the high risk group compared to 75.8 % attendance ( P<0.001 ) and 2.9 % ( P<0.001 ) in the remaining population . Cumulatively , screening of only high risk men with would have required 72.9 % ( 95 % C.I. : 72.3 - 74.5 % ) fewer screening invitations , would have discovered 46.1 % ( 95 % C.I. : 38.9 - 53.4 % ) of the AAA cases diagnosed and prevented 46.7 % ( 95 % C.I. : 28.3 - 65.7 % ) of the AAA-related deaths . However , screening decreased AAA-related mortality both among men with and without known COPD or cardiovascular diseases : mortality ratio : 0.22 ( 95 % C.I. : 0.08 - 0.65 ) , P=0.006 , and 0.24 ( 95 % C.I : 0.09 - 0.63 , P=0.004 , respectively . CONCLUSION High-risk population screening would prevent less than half of AAA-related deaths . Therefore , restricting screening to such high-risk groups does not seem justified , but cost effectiveness analyses are needed to reach a firm conclusion The incidence of abdominal aortic aneurysms ( AAA ) and ruptured AAA is increasing . One to three percent of deaths among 65 - 80 year-old males are caused by AAA . Sixty-six to ninety-five percent of ruptured AAA are lethal , while elective resection has a 3 - 6 % operative mortality . Most AAA 's are asymptomatic before rupture . Ultrasonographic scanning of the aorta takes below ten minutes with close to 100 % sensitivity and specificity . The County of Viborg has started a r and omized screening trial including 13,500 65 - 73 year-old males . Half of these are invited to the nearest hospital over a period of three years . In 1994 - 1995 4938 were invited and 3748 were scanned , result ing in an  acceptance rate  of 76 % . The aorta was visible in 99.7 % , and the total time consumption was 9.7 minutes per scan . The costs were 83.75 DKK per scan . One hundred and fifty-three ( 4.1 % ) had an AAA defined as an aortic diameter above 29 mm . Twenty were above 49 mm and were offered operation , i.e. 5.3 per thous and scans or 13 % of the diagnosed AAA OBJECTIVE Recently generated r and omized screening trial data have provided good evidence in favour of routine screening for abdominal aortic aneurysm ( AAA ) to reduce AAA-related deaths in men aged 65 years and older . We developed an economic model that assessed the incremental cost-utility of AAA screening to help decision makers judge the relevance of a national screening program in Canada . METHODS We constructed a 14 health state Markov model comparing 2 cohorts of 65-year-old men , where the first cohort was invited to attend screening for AAA using ultrasonography ( US )  and the second cohort followed the current practice of opportunistic detection . Lifetime outcomes included the life-years gained , AAA rupture avoided , AAA-related mortality , quality -adjusted life years ( QALYs ) and costs . Transition probabilities were derived from a systematic review of the literature , and a probabilistic sensitivity analysis was carried out to examine the effect of joint uncertainty in the variables of our analysis . The perspective adopted was that of the health care provider . RESULTS Invitations to attend screening produced an undiscounted gain in life expectancy of 0.049 years and a gain in discounted QALY of 0.019 for an estimated incremental lifetime cost of CAN$118 . The estimated incremental cost-utility ratio was CAN$6194 per QALY gained ( 95 % confidence interval [ CI ] 1892 - 10 837 ) . The numbers needed to invite to attend screening , and the numbers needed to screen to prevent 1 AAA-related death were 187 ( 95 % CI 130 - 292 ) and 137 ( 95 % CI 85 - 213 ) , respectively . The acceptability curve showed a greater than 95 % probability of the program 's being cost-effective , and the model was robust to changes in the values of key parameters within plausible ranges . CONCLUSION Our results support the economic viability of a national screening program for men reaching 65 years of age in Canada . More clinical studies are needed to define the role of screening in subgroups at high risk , especially in the female population Context Is it cost-effective to screen older adults for abdominal aortic aneurysm ( AAA ) ? Contribution This 7-year follow-up report of a large r and omized trial in the United Kingdom found that men age 65 to 74 years who were invited to have ultrasonography and surveillance for AAA  had lower mortality rates than did those who were not invited ( hazard ratio , 0.53 [ CI , 0.42 to 0.68 ] ) . Cost-effectiveness for AAA-related deaths , based on costs applied to the events experienced by the men , was estimated at $ 19500 ( CI , $ 12400 to $ 39800 ) per life-year gained . Caution s Only men were studied .  Actual costs of screening and surveillance  may vary substantially in different setting s. The Editors A fast-growing body of literature is providing evidence in favor of screening men for abdominal aortic aneurysm ( AAA ) . Several large , r and omized trials published in the past few years ( 14 ) have consistently shown that screening reduces AAA-related mortality . A few observational studies of programs under way in localized areas have established the feasibility of systematic screening and have explored its practical implementation ( 57 ) . In addition to the mortality benefit , evidence indicating that screening is highly cost-effective is increasing ( 811 ) . In light of this evidence , national screening programs are now being considered in many countries ( 1214 ) . However , there is little evidence regarding long-term outcomes after AAA screening ; almost all of the evidence from r and omized trials is limited to the first 4 years after screening ( 14 ) . Moreover , long-term cost-effectiveness has been estimated only through health economic modeling ( 10 ) . We describe cost-effectiveness based on 7-year follow-up from the largest of the 4 trials of AAA screeningthe Multicentre Aneurysm Screening Study ( MASS ) ( 2 ) . The trial r and omly assigned approximately 67800 men age 65 to 74 years to receive an invitation to screening or to not receive an invitation .  At 4-year follow-up , the trial reported a substantial relative reduction of 42 % ( 95 % CI , 22 % to 58 % ) in AAA-related mortality and an incremental cost-effectiveness ratio of $ 44900 ( CI , $ 24000 to $ 231000 ) per life-year gained ( 9 ) , which is at the borderline of the commonly accepted threshold for interventions . All values are reported in U.S. dollars ( U.K. 1 = U.S. $ 1.58 ) ( 15 ) . The costs of AAA screening are primarily incurred at the start of the program , but benefits continue to accrue in terms of life-years gained in patients in whom AAA rupture is avoided through elective surgery . It is therefore expected that cost-effectiveness of screening will improve over time . The mid-term results of MASS provide reliable , trial-based information regarding clinical outcomes and cost-effectiveness over a longer period . Methods The details of the MASS protocol were described previously ( 2 ) , but a brief summary is provided ( Figure 1 ) . Between 1997 and 1999 , a population -based sample of 70495 men age 65 to 74 years from 4 centers in the United Kingdom was identified by obtaining records for every man in this age range who was registered with a family physician ( registered persons account for approximately 98 % of the population ) . Persons who were ineligible for the trial ( incorrect details , known AAA , previous AAA surgery , or terminal illness ) were excluded before r and omization . The remaining 67770 men were r and omly assigned to receive an invitation to ultrasonography for AAA or to not receive an invitation to ultrasonography . At screening , men with an aortic diameter of 3.0 cm or greater were defined as having an AAA and were subsequently invited for recall scans to monitor growth of the aneurysm . Men with an aortic diameter of 3.0 to 4.4 cm were rescreened every year , and those with an aortic diameter of 4.5 to 5.4 cm were rescreened every 3 months . Participants were considered for elective surgery when the aortic diameter reached 5.5 cm , aortic expansion was 1.0 cm or more in 1 year , or they experienced symptoms attributable to the aneurysm . Men with an aortic diameter less than 3.0 cm on the initial scan were not rescreened . Blood pressure was also measured ; although family physicians were informed of these measurements , no further intervention was provided through the screening program . We obtained approval from local ethics committees at each center , and all patients who had screening provided signed informed consent . Figure 1 . Study flow diagram . Additional data on follow-up scans and AAA surgeries were collected from hospital records . Deaths up to 31 March 2005 were confirmed by the U.K. Office of National Statistics after matching of the unique National Health Service number for each person . Follow-up ranged from 5.9 to 8.2 years ( mean , 7.1 years ) . The primary outcome of interest , AAA-related mortality , is defined as all deaths within 30 days of any AAA surgery ( elective or emergency ) plus all deaths with International Classification of Diseases , Ninth Revision , codes 441.3 ( ruptured abdominal aortic aneurysm ) , 441.4 ( abdominal aortic aneurysm without mention of rupture ) , 441.5 ( ruptured aortic aneurysm at unspecified site ) , or 441.6 ( aortic aneurysm at unspecified site without mention of rupture ) . The use of codes 441.5 and 441.6 may result in inclusion of some thoracic aortic aneurysm deaths . Investigation of the accuracy of cause-of-death coding on the death certificates was done by an independent mortality working party that was blinded to group allocation . The results of this analysis showed that inaccuracies in coding did not have an important impact on study outcomes ( 2 ) . Statistical Analysis All analyses were done by using Stata , version 9 ( Stata Corp. , College Station , Texas ) . Deaths related to AAA ( primary analysis ) and all-cause mortality ( secondary analysis ) were compared between the 2 r and omized groups by using unadjusted Cox regression by intention-to-treat analysis . Adjustment for age at baseline did not influence the results . The proportional hazards assumption was tested by using Schoenfeld residuals . An unbiased r and omization-based estimate of the benefit of  screening  was also obtained ( 16 ) . This estimate is calculated by subtracting from the control group a subgroup that is equivalent in terms of survival to the nonadherent subgroup in the invited group . Thus , the remaining controls are comparable to the group of invited patients who attended screening . Life-years gained are estimated as the area between the KaplanMeier curves for both groups ( 17 ) . The cost-effectiveness of screening  is estimated from a health service perspective for follow-up truncated at 7 years , with adjustment for censoring ( 18 ) . Details of the costing exercise in the trial at 20002001 prices were reported previously ( 9 ) . The unit costs obtained ( U.K. 1 = U.S. $ 1.58 for the year 2000 [ 15 ] ) are inflated to the 20042005 financial-year level by using annual hospital and community health services pay and price inflation indices ( 19 ) . Costs are applied to the following events on the basis of individual re source use : invitation to screening ( $ 2.46 ) , reinvitation after nonresponse ( $ 2.42 ) , initial scan ( $ 35.95 ) , recall scan ( $ 86.74 ; done in the hospital rather than in the community and including costs for periodic routine meetings with a consultant ) , consultation for elective surgery ( $ 583.79 ) , elective AAA surgery ( $ 13015.74 ) , and emergency AAA surgery ( $ 21054.32 ) . Costs relating to scans of incidentally detected AAAs in the control group are not included ( data not available ) , but costs relating from result ant AAA repair surgery are included . Sensitivity analyses were done by using 1 ) costs retained at the 20002001 financial-year level for comparison with previous publications , 2 ) quality -adjusted life-years based on age-related reductions , 3 ) U.S.-based unit cost estimates for scans and surgeries , 4 ) an increase of 50 % in the cost of a consultation  ( a U.S.-based estimate was not available , but this analysis reflects possible additional assessment s ) , 5 ) 3 and 4 combined . Quality -of-life adjustments are made only on the basis of age , with an adjustment of 0.78 for life-years gained between the ages 65 and 74 years and an adjustment of 0.75 for life-years gained at ages older than 75 years ( 20 ) . The U.S.-specific estimates for scans ( initial and recall ) are based on Medicare reimbursement for AAA screening at $ 90.95 ( Current Procedural Terminology code G0389 ) ( 21 ) , and U.S.-specific costs for surgeries are based on previously published estimates ( 22 , 23 ) that were inflated to 2004 prices ( 24 ) : $ 18160 for elective procedures and $ 31106 for emergency procedures . Discounting is applied at the current recommended values of 3 % per annum for costs and effects ( 25 ) . Estimates of AAA-related costs and effects take into account the rate of nonAAA-related deaths across both groups over time . The Fieller method is used to calculate bounds for the CI for cost-effectiveness ( 26 , 27 ) . Role of the Funding Source This study was funded by the Medical Research Council . The funding source had no role in the design , implementation , or analysis of the study . Results Figure 1 shows the flow of participants through the trial . Numbers differ slightly from earlier publications because of identification of a few duplicate records in the data base . Of 67770 r and omly assigned men , 33883 were invited to be screened : 27204 ( 80 % ) attended and 1334 ( 4.9 % ) AAAs were identified . The mean age at r and omization was 69.2 years in both groups . Loss to follow-up because of death was 2.1 % overall ( 2.2 % in the control group and 2.1 % in the invited group ) . Loss to clinical follow-up ( nonattendance at recall scans ) was 19 % at 4 years and 24 % at 7 years . The Appendix Table shows surgeries and deaths within 30 days in each of the r and omly assigned groups . A few endovascular operations are included in these figures6 in the control group and 14 in the invited group . As expected , the total number of elective procedures is greater in the invited group than in the control group OBJECTIVES to analyse the hospital costs and benefits of screening  older males for abdominal aortic aneurysm ( AAA ) . MATERIAL S AND METHODS in 1994 a hospital-based screening trial of 12 658 65 - 73-year-old males was started . AAA > 5 cm were referred for surgery . The remaining AAA were offered annual scans . Those with aortic ectasia were rescreened at 5 yearly intervals . AAA-operations and hospital AAA-related deaths were research ed . The costs of screening , surveillance , and treatment  were also registered . RESULTS the attendance rate was 76 % ; of whom 191 ( 4.0 % ) had AAA . Mean observation time was 5.13 years . Sixty in the screened and 41 in the control group were operated ( p=0.06 ) , of which 7 and 27 respectively were operated as an emergency ( p<0.001 ) , and 6 and 19 respectively died due to AAA ( p=0.009 ) . The costs per scan were 83.50 DKK , 81 400 DKK per emergency operation ( 71 485 DKK after screening ) , and 117 000 DKK per emergency operation . The cost per prevented hospital death was 67 855 DKK , equivalent to approximately life year saved approx . 7540 DKK ( GBP1=12 DKK ) . CONCLUSION screening appears to reduce hospital AAA mortality and to be cost-effective Physicians must make decisions about screening patients for abdominal aortic aneurysms ( AAAs ) , monitoring or referring for surgery patients with AAAs of various sizes , and assessing patients with symptoms that may be related to AAAs . This review article analyzes the evidence for each scenario . The effectiveness and cost-effectiveness of screening for AAA is based on results from four r and omized controlled trials . A cost-effectiveness analysis using a Markov model showed that ultrasound screening of white men beginning at age 65 is both effective and cost-effective in preventing AAA-related death . Such screening would have a small but real impact over a 20-year period in these men . For patients with a known AAA — which is often detected incidentally — the evidence clearly suggests periodic ultrasound surveillance for those with small AAAs ( 3.0–3.9 cm in diameter ) and elective surgical repair for those with large AAAs ( = 5.5 cm ) . Two recent r and omized controlled trials have shown that early surgical repair confers no survival benefit compared with periodic surveillance for patients with intermediate-sized AAAs ( 4.0–5.5 cm in diameter ) , so those patients can also be monitored . Some centers choose to increase the frequency of monitoring to every 3 to 6 months when the AAA reaches 5.0 cm . Factors to consider in assessing symptomatic patients include the high risk of life-threatening conditions , the potential increased risk of death or poor outcome with delay in diagnosis , the limitations of ultrasound in identifying whether symptoms are due to known or suspected AAA , and the timely availability of computed tomography or other imaging tests . If available , computed tomography is preferred in patients with recent or severe symptoms , since it is better at detecting retroperitoneal hemorrhage and other complications and in providing preoperative definition of the anatomy BACKGROUND At present , several regions and countries are considering screening for abdominal aortic aneurysm ( AAA ) . However , The Chichester Aneurysms Screening Trial has reported poor long term benefit of screening for AAA . We therefore supplement previously published data with a preliminary analysis of the ten-year mortality from AAA , based upon population -based data until 2002 ( 7 years ) and incomplete hospital-based information on deaths until 2005 ( 10 years ) . METHODS AND MATERIAL In 1994 we started a r and omised screening trial of 12,639 64 - 73 year-old males ; 6,306 were controls , and 6,333 were invited to an abdominal ultrasound scan at their district hospital . Information on all deaths until 15.3.2005 was obtained from the Office of Civil Registration . Information on AAA related deaths was obtained from the national registry of Causes of Deaths from 1.4.1994 to 31.12.2001 , and supplemented with AAA deaths known to the Danish National Patient Registry until 15.3.2005 . Operations were obtained from the Danish National Vascular Registry from 1.4.1994 to 15.3.2005 . Death certificates and medical records were review ed by two independent assessors . The analyses were based on " intention to treat " from the date of r and omisation . RESULTS The attendance rate was 76.6 % and 191 ( 4.0 % ) had an AAA . The median observation time was 9.58 years . In the invited group 13 subjects were acutely operated on compared to 40 in the control group ( Risk ratio : 0.32 ( 95 % C.I. 0.17 - 0.60 , P<0.001 ) ) , and 14 died due to AAA compared to 51 in the control group ( Hazard ratio : 0.27 ( 95 % C.I. : 0.15 - 0.49 , P<0.001 ) . CONCLUSION Over ten years , screening reduced mortality from AAA by 73 % , and the frequency of emergency operations by 68 % AIM To investigate the efficacy of a single ultrasonic scan at age 65 to identify patients at risk from ruptured abdominal aortic aneurysm ( AAA ) . METHOD A total of 6058 men aged 64 - 81 were recruited to a r and omised trial , and 3000 were invited to attend a single  screening test . An additional population of 1011 men was offered screening as they reached age 65 . If a normal aorta was identified in this sub-group , further scans were offered at two-yearly intervals . Follow up and treatment of those identified as having an aortic dilatation of 3 cm or greater was undertaken . All subject groups were monitored for deaths occurring over the study period , and date and cause of death were recorded . RESULTS A total of 2212 men attended screening in the r and omised trial ; the overall compliance was 74 % , and prevalence of AAA was 7.7 % . Compliance decreased , and prevalence increased , with age . Mortality from ruptured AAA was reduced by 68 % at 5 years ( screened group compared to the age-matched control population ) , and by 42 % in the study arm ( screened and refusers ) compared with controls . The benefit persisted at ten years ( 53 % and 21 % respectively ) . Of the uncontrolled sample of 1011 men offered a scan at age 65 , 681 attended and 649 of these were found to have a normal aortic diameter ; re-screening demonstrated new aneurysm development in 4 % over ten years . The aortic diameters of the new AAAs were under 4 cm and would therefore have a low risk of rupture.1 Mortality from rupture in all those with an initially normal aortic diameter was low , at 1 case per 1000 scans over ten years . CONCLUSION Screening once for AAA at age 65 can identify the majority of AAA that are of clinical significance and can identify a large population at low risk from rupture who do not require surveillance . This policy has been effective when combined with selective treatment in reducing the risk of rupture for ten years in those who attend the screening programme INTRODUCTION The hospital costs and benefits of screening older males for abdominal aortic aneurysms ( AAA ) are unknown . MATERIAL AND METHODS In 1994 , a  hospital-based screening trial of 12,658 65 - 73-year-old males in the County of Viborg , Denmark , was started . AAA > 5 cm were referred for surgery . The remaining AAA were offered annual control scans . Those with aortic ectasia ( def . : 2.5 - 2.9 cm ) were rescreened at 5-year intervals . AAA-operations and deaths of AAA at hospital were registered . Finally , costs of screening , surveillance , and treatment were registered . Data on causes of death outside hospitals could not be obtained . RESULTS The attendance rate was 76 % , of whom 191 ( 4.0 % ) had AAA . The average observation time was 5.13 years . 60 in the screened and 41 in the control group were operated ( P = 0.06 ) , 7 and 27 were operated as an emergency ( P < 0.001 ) , and 6 and 19 died at the hospitals due to AAA ( p = 0.009 ) . The costs per scan were 83.50 DKK , 81,400 DKK per elective operation ( 71,485 DKK after screening ) , and 117,000 DKK for an emergency operation . The costs per prevented hospital death were 67,855 DKK or approx . 7,540 DKK per life year saved ( 1 GBP = 12 DKK ) . DISCUSSION Screening older males for AAA in Denmark seems very cost-effective and reduces hospital mortality of AAA by 68 % and probably the overall AAA-specific mortality by 73 % The Multicentre Aneurysm Screening Study ( MASS ) provided strong evidence for both the clinical benefit and the cost‐effectiveness of a screening programme for  abdominal aortic aneurysms ( AAAs ) in men . If a national screening programme for AAA were adopted in the UK , it would be expected to increase the elective and decrease the emergency surgical workload Objectives To investigate the feasibility of selective screening for abdominal aortic aneurysm ( AAA ) based on identification of a target group of manageable size defined by risk factors for AAA . Setting Male residents of Perth , Western Australia , aged 65–83 years , who participated in a r and omised controlled trial of ultrasound screening for AAA . Methods Eligible men were identified from the electoral roll and invited to attend a  screening clinic . Those who attended completed a question naire , had a limited physical examination , and underwent an ultrasound examination to identify the maximum diameter of the infrarenal aorta . Data on risk factors collected from the first 8995 men seen were used to calculate a multivariate risk score for the remaining 2755 men who were screened . Centiles of the risk score were used to define potential target groups for screening and the sensitivity and specificity of each of these selective screening strategies were calculated . We repeated the calculation separately for AAAs of at least 30 mm , 40 mm , and 50 mm in diameter . Results We found that screening half of the male population aged 65–83 years would find approximately 75 % of AAAs , regardless of their size , whereas screening only current smokers in this population would find approximately 20 % of AAAs . Conclusions Selective screening for AAA using easily recognisable risk factors is feasible but is not worthwhile as approximately 25 % of clinical ly significant cases would be missed The objective of this study was to evaluate the effect on quality of life ( QOL ) of screening for abdominal aortic aneurysm ( AAA ) in a population -based AAA screening program . Twenty-four patients with screening-detected AAA and 45 controls with normal aortic diameter were studied in a prospect i ve , controlled , population -based study . Prior to and 12 months after the ultrasonography examination , all participants completed  Short-Form 36  and at 12 months , 10 AAA-specific questions were added . Comparisons were made between the two groups ( AAA patients and controls ) , within each group , and between the groups and norms for the general Swedish population in the same age interval . Our results showed that screening for AAA results in impairment of QOL among those who have the disease and who suffered a low QOL prior to screening . Among those who had an age-adjusted normal QOL prior to screening and who were found to have the disease , and among those who were found to have normal aortas , no negative effect on QOL was observed . Thus , low QOL before screening is a possible risk factor for negative mental effects of diagnosing an AAA by screening BACKGROUND The aim of the study was to analyse whether the selection and recruitment for hospital-based mass screening for abdominal aortic aneurysms ( AAA ) is acceptable for the population according to the criteria from the Council of Europe . METHODS A r and om sample of 4404 65 - 73-year-old males were invited to  hospital-based mass screening for AAA . As methods of secondary recruitment , they could change their time of appointment , and non-responders were reinvited once . RESULTS The attendance rate was 76 per cent ; 4.2 per cent had AAA . Men with cardiopulmonary and vascular diseases had higher attendance rate ( 80.5 per cent ) , and prevalence of AAA ( 9.1 per cent ) . Men with potentially mobility-disabling diseases also had a higher attendance rate ( 80.4 per cent ) . However , possible unfavourable social selection was noticed in the group of retired men with no information of former occupation . They had 68.5 per cent attendance , and 7.6 per cent AAA . If true , this selection decreases the number of potentially diagnosed AAA by only 2 per cent . Opportunity of revised appointment and reinvitation of non-responders increased the primary attendance of 65 per cent to 76 per cent . More AAA were found at secondary scans ( 6.3 per cent compared with 3.9 per cent ) . CONCLUSION The attendance rate fell markedly with age , but the recruitment was high even at the age of 73 , and travel distance and social class did not markedly influence uptake . A positive morbidity selection to screening for AAA was observed for cardiovascular or pulmonary diseases and potentially mobility-disabling diseases . Furthermore , higher prevalence of AAA was found for initial nonattenders . Thus , screening for AAA seems acceptable to the population , and extra efforts to increase the attendance are beneficial without increased costs per diagnosed AAA . Finally , if mass-screening proves to be cost-ineffective , selective screening of patients with hypertension or ischaemic heart disease might be beneficial Aortic aneurysm is the 10th leading cause of death in older men [ 1 ] , but fundamental issues about the cause and epidemiology of this condition remain unresolved . A fourfold variation in the prevalence of abdominal aortic aneurysm ( AAA ) has been seen among participants in screening programs [ 2 ] , and the traditional view that AAA is a manifestation of atherosclerosis has been challenged by recent studies that suggest a role for specific genetic factors [ 3 ] . Most information on the epidemiology of AAA has come from screening studies [ 4 - 10 ] . However , the studies that have reported on potential risk factors have screened fewer than 5500 patients each , result ing in too few cases for multivariable analysis . Two nested casecontrol studies have reported multiple risk factor analyses for aortic aneurysms [ 11 , 12 ] , but these studies were also relatively small ( one contained 41 and one contained 165 aneurysms ) , did not attempt to identify all cases of AAA in their study population s , did not consider such important factors as family history of AAA , and disagreed about the significance of such factors as height and serum cholesterol levels . To identify factors that are independently associated with AAA and to determine the prevalence of previously unrecognized AAA in defined demographic and risk groups , we collected and analyzed self-reported information from a large cohort of veterans who participated in a multicenter ultrasonographic screening program . Methods Participants The Aneurysm Detection and Management ( ADAM ) study is an ongoing r and omized clinical trial comparing two strategies for the management of AAA ( immediate surgery and surgery reserved for aneurysms that enlarge to 5.5 cm , enlarge rapidly , or cause symptoms ) in patients 50 to 79 years of age with asymptomatic AAAs 4.0 to 5.4 cm in diameter [ 13 ] . Ultrasonography screening clinics were established at the 15 participating Department of Veterans Affairs medical centers to support recruitment into the trial . Active patients at these centers ( that is , patients treated during the current or previous fiscal year and those who had future appointments ) who met the age criteria for the study were invited by mail to attend the clinic . Throughout the screening period , the letters were mailed in batches according to patient social security number using the continuously up date d administrative patient data at each participating center . A second mailing that was done at some centers excluded persons who had previously been seen in the screening clinic . Active patients at the participating centers were also accepted for screening on a walk-in basis ; patients 50 to 79 years of age were included in the analysis because they were members of the target population and eventually would have been invited to participate . Inadvertent repeated screenings were identified by patient social security number , and results of second screenings were excluded . Patients who reported previously having been told that they had an AAA were also excluded . We include data from patients who were screened from the beginning of the program in October 1992 through March 1995 . The study was approved by the human rights committee at the Veterans Affairs Cooperative Studies Program coordinating center and by the institutional review boards at the 15 participating centers . Assessment of Associated Factors Before ultrasonographic examination , all patients completed a brief  question  naire that asked about demographic information and possible risk factors for AAA . Patients were asked whether they had ever been told by a physician that they had the condition in question ( for example , high blood pressure ) . The question naire was developed for the study , tested at the participating centers , and revised accordingly before the study began . The reliability of the data from the self-reported question naire was assessed by comparing this data with data collected in the subset of screened patients who had an AAA and who were later included in the clinical trial . These data were recorded by a study nurse after discussion with the patient and review of the patient 's medical records . Ascertainment of Abdominal Aortic Aneurysm The abdominal aorta was measured above and below the renal arteries using a 3.5-MHz real-time sector scanner . The ultrasonographers were instructed to 1 ) scan the aorta in the anteroposterior and lateral planes and 2 ) report the maximum external diameter at the widest point of any dilatation for the suprarenal and infrarenal segments . The ultrasonographers met twice during the study period to review techniques and compare measurement distributions . Patients found to have an AAA or another suspected abnormality were referred for evaluation , and discrepancies between the results of subsequent testing and the results of the initial screening were reported back to the study ultrasonographer . Screening appointments for patients whose examinations were inadequate because of insufficient fasting were rescheduled . An infrarenal aortic diameter of 4.0 cm or larger is generally agreed to constitute AAA , but no method for defining a smaller AAA has gained wide acceptance [ 14 ] . Most investigators have used unadjusted aortic diameter ( with such cutoff points as 3.0 cm , which is known to be associated with risk for rupture [ 15 ] ) but this practice may exaggerate the prevalence of AAA in larger people . To avoid this problem , use of a ratio of infrarenal aortic diameter to suprarenal aortic diameter of 1.5 or greater has been proposed [ 14 ] . However , this method labels some small aortas as having an AAA and fails to account for aneurysmal dilatation of the suprarenal aorta . The latter problem has , in turn , been addressed by a proposal to define AAA as an aortic diameter more than 1.5 times the diameter that would be expected on the basis of age , sex , body size , and other factors . However , values for the expected diameter have not been well defined [ 14 ] . Therefore , we considered several definitions of AAA , including an infrarenal aortic diameter of at least 3.0 cm , a diameter of at least 4.0 cm , and a ratio of infrarenal to suprarenal aortic diameter of 1.5 or greater . Statistical Analysis Analyses to determine the association between the items on the question naire and the presence of AAA were done using univariable and multivariable logistic regression . Because the purpose of the analysis was descriptive , the multivariable models included all variables that were considered in the question naire . Composite variables were formed from several questions that were used to identify coronary artery disease ; hypertension ; hypercholesterolemia ; and , in a separate analysis , any atherosclerosis . Responses of do n't know were treated as responses of no for specific diseases under the assumption that if a person had a disease , he or she would be aware of it . This assumption was not made for hypercholesterolemia or hypertension , which are often asymptomatic ; responses of do n't know for these conditions were considered to be missing . Because of the result ing large number of missing responses for hypercholesterolemia , an indicator variable was included for this item to prevent deletion of these patients from the logistic models ( as was otherwise done for missing responses ) [ 16 ] . Extreme values for height ( < 152 cm and > 198 cm ) , weight ( < 45 kg and > 182 kg ) , waist circumference ( < 56 cm and > 152 cm ) , and cholesterol levels ( < 2.59 mmol/L and > 12.93 mmol/L ) and smoking history incompatible with age were also excluded . To compare the many cases of smaller , borderline AAA with cases of larger , definite AAA , separate regression models were developed 1 ) for comparing patients who had AAAs of 3.0 to 3.9 cm with those who had infrarenal aortic diameters less than 3.0 cm and 2 ) for comparing those who had AAAs of 4.0 cm or larger with those who had infrarenal aortic diameters less than 3.0 cm . A third model was developed for comparing patients whose ratio of infrarenal to suprarenal aortic diameter was 1.5 or greater with those whose ratio was less than 1.5 . Comparison of question naire data with data collected for the clinical trial was made for categorical variables by using percent-pair agreement and the statistic and for continuous variables by using the mean difference ( question naire value minus clinical trial value ) and limits of agreement ( the range within which 95 % of the differences would be expected to occur , calculated as the mean difference 1.96 times the SD of the differences [ 17 ] ) . Results During the study period , 320 000 letters were mailed ; 5.3 % of these were returned because of an invalid address or death . Of the remaining letters , 30 % ( 91 000 letters ) were returned by persons willing to be screened . A total of 73 943 persons who were 50 to 79 years of age and did not have a history of AAA were screened ; 492 were excluded because the aorta could not be visualized . The remaining 73 451 patients constitute the study group , of whom 3.5 % were walk-ins . As Table 1 shows , the study group consisted primarily of men who had a history of smoking ( 97.2 % were male ; 75.5 % had a history of smoking ) . This closely reflects the population of U.S. veterans ( 96 % are male ; 74 % have a history of smoking [ 18 ] ) ; however , the study group also included 2078 women and 17 981 persons who had never smoked . Table 1 . Characteristics of 73 451 U.S. Veterans 50 to 79 Years of Age Screened for Abdominal Aortic Aneurysm * Abdominal aortic aneurysm , defined as an infrarenal aortic diameter of 3.0 cm or more , was detected in 3366 patients ( 4.6 % ) ; the infrarenal aortic diameter was at least 4.0 cm in 1031 patients ( 1.4 % ) . The frequencies of larger AAAs were as follows : Three hundred sixty-eight ( 0.50 % ) patients had an AAA of 5.0 cm or larger , 224 ( 0.30 % ) patients had an AAA of 5.5 cm or larger , 137 ( 0.19 % ) patients had an AAA of 6.0 cm or larger , 48 ( 0.07 % ) patients had an AAA of 7.0 cm or larger , and 22 ( 0.03 % ) patients had an AAA of 8.0 cm or larger . It can OBJECTIVE To describe the potential psychological consequences of screening for abdominal aortic aneurysms ( AAAs ) . METHODS The participants were prospect ively and r and omly sample d from a r and omised screening trial for AAA and asked to complete a vali date d generic and global anonymous quality of life ( QL ) question naire by self- assessment ( ScreenQL ) . Material case-control study : ScreenQL was completed once by 168 ( 48 % ) of 350 non-responders to screening  , 271 ( 81 % ) of 335 attenders before screening , 286 ( 85 % ) of 335 attenders after screening , 127 ( 85 % ) of 149 with a small AAA diagnosed at screening , and 231 ( 66 % ) of 350 who were r and omised not to be offered screening for AAA ( controls ) . Prospect i ve study ( paired data ): 127 men having a small AAA diagnosed . Twenty-nine ( 81 % ) of 36 men operated after initial conservative treatment . RESULTS Initially , the QL score was 5 % lower among men with a small AAA compared to the controls ( p<0.05 ) , mainly because of poorer health perception . The QL score declined significantly further to 7 % below control values during the period of conservative treatment . This impairment was mainly due to a 21 % and 15 % reduction in scores relating to health perception and psychosomatic distress , respectively . However , all scores improved to control levels in patients operated on . The QL of attending men for screening was significantly lower than that of the controls and the attenders after the screening . No differences were noticed concerning the non-attenders . CONCLUSION The offer of screening causes transient psychological stress in subjects found not to have AAA . However , diagnosis of an AAA seems to impair QL permanently and progressively in conservatively treated cases . This impairment seems reversible by operation . Nevertheless , the impairment seems considerable , and must be considered in the management of AAA and in the final evaluation of screening for AAA In a 1997 report of a large  abdominal aortic aneurysm ( AAA ) screening study , we observed a negative association between  diabetes and AAA .  Although this was not previously described and negative associations between diseases are rare , the credibility of the finding was supported by consistent results in several previous studies and by the absence of an obvious artifactual explanation . Since that time , a variety of studies of AAA diagnosis , both by screening and prospect i ve clinical follow-up , have confirmed the finding . Other studies have reported slower aneurysm enlargement and fewer repairs for rupture in diabetics . The seeming protective effect of diabetes for AAA contrasts with its causal role in occlusive vascular disease and so provides a strong challenge to the traditional view of AAA as a manifestation of atherosclerosis . Research focused on a protective effect of diabetes has already increased our underst and ing of the etiology of AAA , and might eventually pave the way for new therapies to slow AAA progression Screening for abdominal aortic aneurysm ( AAA ) is commonly restricted to men . Recent studies have indicated a possible increase in deaths due to ruptured AAA in women , and a higher rate of rupture in women than in men . The present report details results from a r and omized controlled trial that assessed the effects of screening women for AAA The major goal of the U.S. Preventive Services Task Force ( USPSTF ) is to provide clinicians and policymakers with a reliable and accurate source of evidence -based recommendations on a wide range of preventive services . To accomplish this goal , the USPSTF systematic ally review s the evidence concerning both the benefits and harms of widespread implementation of a preventive service . It then assesses the certainty of the evidence and the magnitude of the benefits and harms . On the basis of this assessment , the USPSTF assigns a letter grade to each preventive service signifying its recommendation about provision of the service ( Table 1 ) . Table 1 . U.S. Preventive Services Task Force Recommendation Grid * An important , but often challenging , step is determining the balance between benefits and harms to estimate net benefit ( that is , benefits minus harms ) . In this issue , the Task Force reports an up date to its recommendation for carotid artery stenosis screening ( 1 , 2 ) . Because carotid artery stenosis screening has both known benefits and harms , estimating net benefit was critical in the final USPSTF recommendation that clinicians not provide carotid artery stenosis screening in asymptomatic people ( recommendation letter grade D ) . Release of this recommendation provides an opportunity for the Task Force to up date and explain to a clinical audience the process by which it evaluates evidence , determines the certainty and magnitude of net benefit , and gives a letter grade to the recommendation . We will do this by considering 3 questions : 1 ) What evidence does the Task Force consider to estimate net benefit ? 2 ) How does the Task Force estimate the certainty of net benefit ? and 3 ) How does the Task Force estimate the magnitude of net benefit ? What Evidence Does the Task Force Consider to Estimate Net Benefit ? The overarching question that the Task Force seeks to answer for every preventive service is whether evidence suggests that provision of the service would improve health outcomes if implemented in a general primary care population . For screening topics , this st and ard could be met by a large r and omized , controlled trial ( RCT ) in a representative asymptomatic population with follow-up of all members of both the group invited for screening and the group not invited for screening . For example , the Multicentre Aneurysm Screening Study ( 3 ) was a population -based RCT of screening for abdominal aortic aneurysm in which 67800 asymptomatic men age 65 to 74 years in the United Kingdom were r and omly assigned to be invited or not to be invited for screening . Both groups were followed for a mean of 4.1 years , and abdominal aortic aneurysmrelated mortality and all-cause mortality were compared . No RCTs of carotid artery stenosis screening have been published ; however , RCTs comparing carotid endarterectomy to medical management of asymptomatic carotid artery stenosis are available . The distinction between RCTs that r and omly assign people to undergo screening  versus RCTs that r and omly assign people known to have a condition to an intervention is important . In contrast to the latter , RCTs of screening take into account the false-positive and false-negative rates of the screening test , the possibility of adverse events from the test , the accuracy and potential for adverse events of any subsequent confirmatory diagnostic tests , and the inevitable failure to follow through on the test or any subsequent steps needed before the therapeutic intervention is delivered . In addition , conditions detected by screening may have different biological characteristics than those detected in other ways . The benefits of treating screened individuals , therefore , can not be assumed to be the same as those of treating symptomatic individuals . Screening trials directly answer a simple question important to the primary care setting : Does screening for a certain condition improve health outcomes ? Direct RCT evidence about screening is often unavailable , so the Task Force considers indirect evidence . To guide its selection of indirect evidence , the Task Force constructs a chain of evidence within an analytic framework . Figure 1 of the evidence up date ( 2 ) in this issue ( page 861 ) shows the analytic framework for the Task Force assessment of carotid artery stenosis screening . Each arrow in the framework defines a key question , and each key question represents a link in the chain of evidence . Rectangles in the framework represent the intermediate outcomes ( rounded corners ) or the health outcomes ( square corners ) ; ovals represent harms . To form an unbroken chain , evidence must support each link in the chain , thereby connecting the target population ( far left side of the framework ) to the improved health outcome ( far right side of the framework ) . For each key question , the body of pertinent literature is critically appraised , focusing on 6 questions ( Table 2 ) . The USPSTF will now describe its judgment about the evidence for each key question as convincing , adequate , or inadequate . Evidence may be considered convincing when derived from several high- quality studies with consistent , logical results that are generalizable to the U.S. primary care population and setting . Evidence may be deemed adequate when , on the basis of judgment , most but not all of these 6 questions are answered favorably . When evidence is conflicting or the studies are of poor quality individually or in aggregate , the evidence for a key question is considered inadequate . Inadequate evidence may create a critical gap in the evidence chain . Table 2 . Questions Considered by the U.S. Preventive Services Task Force for Evaluating Evidence Related Both to Key Questions and to the Overall Certainty of the Evidence of Net Benefit for the Preventive Service How Does the Task Force Estimate the Certainty of Net Benefit ? The next step in the Task Force process is to use the evidence from the key questions to assess whether there would be net benefit if the service were implemented . In 2001 , the USPSTF published an article that documented its systematic processes of evidence evaluation and recommendation development ( 4 ) . At that time , the Task Force 's overall assessment of evidence was described as good , fair , or poor . The Task Force realized that this rating seemed to apply only to how well studies were conducted and did not fully capture all of the issues that go into an overall assessment of the evidence about net benefit . To avoid confusion , the USPSTF has changed its terminology . Whereas individual study quality will continue to be characterized as good , fair , or poor , the term certainty will now be used to describe the Task Force 's assessment of the overall body of evidence about net benefit of a preventive service and the likelihood that the assessment is correct . Certainty will be determined by considering all 6 questions in Table 2 ; the judgment about certainty will be described as high , moderate , or low . In making its assessment of certainty about net benefit , the evaluation of the evidence from each key question plays a primary role . It is important to note that the Task Force makes recommendations for real-world medical practice in the United States and must determine to what extent the evidence for each key question even evidence from screening RCTs or treatment RCTs can be applied to the general primary care population . Frequently , studies are conducted in highly selected population s under special conditions . The Task Force must consider differences between the general primary care population and the population s studied in RCTs and make judgments about the likelihood of observing the same effect in actual practice . For carotid artery stenosis screening , the Task Force search ed for evidence about the true prevalence of high- grade carotid artery stenosis in the general population , the generalizability of treatment effectiveness estimates based on RCTs conducted in selected population s , and the complication rate from carotid endarterectomy in asymptomatic individuals if performed in nontrial setting s ( for example , community hospitals ) . It is also important to note that 1 of the key questions in the analytic framework refers to the potential harms of the preventive service . The Task Force considers the evidence about the benefits and harms of preventive services separately and equally . Data about harms are often obtained from observational studies because harms observed in RCTs may not be representative of those found in usual practice and because some harms are not completely measured and reported in RCTs . For example , the surgeons who enrolled patients in RCTs of carotid artery stenosis were selected on the basis of their low postoperative stroke and mortality rates . Widespread screening for carotid artery stenosis would invariably lead to surgical treatment provided in hospitals ( or by surgeons ) with higher rates of complications . The harms of screening for carotid artery stenosis , including the harms from carotid angiography to confirm the diagnosis of carotid artery stenosis in patients screening positive by carotid ultrasonography  , were not captured in some treatment RCTs . Putting the body of evidence for all key questions together as a chain , the Task Force assesses the certainty of net benefit of a preventive service by asking the 6 major questions in Table 2 . The Task Force would rate a body of convincing evidence about the benefits of a service that , for example , derives from several RCTs of screening in which the estimate of benefits can be generalized to the general primary care population as high certainty ( Table 3 ) . The Task Force would rate a body of evidence that was not clearly applicable to general practice or has other defects in quality , research design , or consistency of studies as moderate certainty . Certainty is low when , for example , there are gaps in the evidence linking parts of the analytic framework , when evidence to determine the harms of treatment is unavailable , or BACKGROUND Based on r and omized , population -based screening protocol s , a single ultrasound examination reduces mortality from an abdominal aortic aneurysm ( AAA ) by facilitating elective surgical intervention before rupture . Ultrasound screening is accurate , noninvasive , inexpensive , and cost effective . By using a comprehensive electronic medical record , we inquired whether an age-prompted clinical reminder would facilitate the detection of AAA . METHODS The  AAA risk screen  was installed in May 2007 via a computerized patient record system prompt for male veterans ages 65 to 75 who ever smoked . This abbreviated ultrasound examination uses a 3.5- to 4-MHz scan head , measures anteroposterior and transverse planes , and reports the largest infrarenal aortic diameter . RESULTS Of 1437 examinations there were 73 AAAs of 3.0-cm diameter or larger ( 5.1 % ) ; 33 AAAs of 4.0-cm diameter or larger ( 2.3 % ) ; 15 AAAs of 5.0-cm diameter or larger ( 1.0 % ) ; and 11 AAAs of 5.5-cm diameter or larger ( .77 % ) . Fifty ( 68 % ) received counseling for abnormal findings . CONCLUSIONS Recognition of newly diagnosed AAA compared favorably with that of previous screening studies . Electronic clinical reminders identify undiagnosed , life-threatening AAAs before rupture . Immediate counseling is available in the vascular setting An ultrasonography screening programme for detecting abdominal aortic aneurysm ( AAA ) in the community is described in which 7200 men and women aged between 65 and 80 years were contacted by letter . Of these , 4237 were screened ; the aorta was visualized in 4122 and 179 AAAs of 3 cm or more in diameter were detected ( 4.3 per cent ) . Criteria for surgery are suggested and the results of their application prospect ively over 6 years are discussed . Using these criteria , under 10 per cent of patients with ultrasonographically‐detected AAA should require surgery for this condition provided ultrasonography follow‐up is used Ruptured abdominal aortic aneurysms ( RAAA ) have a 78 - 94 % mortality rate . If cost-effectiveness of screening programs for abdominal aortic aneurysms ( AAA ) are to be assessed , direct costs for RAAA repairs and elective AAA ( EAAA ) repairs are required . This study reports mortality , morbidity , and direct costs for  RAAA and EAAA repairs in Nova Scotia in 1997 - 1998 and also compares Nova Scotia and U.S. costs . We performed a retrospective study of 41 consecutive RAAA and 48 r and omly selected EAAA patients .  Average total costs for RAAA repair were significantly greater than those for EAAA repair ( direct costs : $ 15,854 vs. $ 9673 ; direct plus overhead costs : $ 18,899 vs. $ 12,324 [ pricing in 1998 Canadian dollars ] ) . Intensive care unit length of stay and blood product usage were the most substantial direct cost differentials ( $ 3593 and $ 2106 ) . Direct cost for preoperative testing and surveillance was greater in the EAAA group ( $ 839 vs. $ 33 ) . Estimates of U.S. in-hospital RAAA and EAAA repair costs are more than 1.5 times Nova Scotia costs . Direct in-hospital RAAA repair costs are $ 6181 more than EAAA repair costs . These in-hospital cost data are key cost elements required to assess the cost-effectiveness of various screening strategies for earlier detection and monitoring of AAA within high-risk population s in Canada . Further studies are required to estimate cost per quality -adjusted-life-year gained for various AAA screening and monitoring strategies in Canada
Electronic reminders are a simple EMR addition that can provide evidence -based education while improving adherence rates with preventive health screening measures
Abstract : The 2014 United States Preventive Services Task Force systematic review found abdominal aortic aneurysm ( AAA ) screening decreased related mortality by close to half .
Despite the simplicity of screening , research suggests poor adherence to the recommended AAA screening guidelines .