Abdominal aortic aneurysm screening program using hand-held ultrasound in primary healthcare

PLoS One. 2017 Apr 28;12(4):e0176877. doi: 10.1371/journal.pone.0176877. eCollection 2017.

Abstract

We determined the feasibility of abdominal aortic aneurysm (AAA) screening program led by family physicians in public primary healthcare setting using hand-held ultrasound device. The potential study population was 11,214 men aged ≥ 60 years attended by three urban, public primary healthcare centers. Participants were recruited by randomly-selected telephone calls. Ultrasound examinations were performed by four trained family physicians with a hand-held ultrasound device (Vscan®). AAA observed were verified by confirmatory imaging using standard ultrasound or computed tomography. Cardiovascular risk factors were determined. The prevalence of AAA was computed as the sum of previously-known aneurysms, aneurysms detected by the screening program and model-based estimated undiagnosed aneurysms. We screened 1,010 men, with mean age of 71.3 (SD 6.9) years; 995 (98.5%) men had normal aortas and 15 (1.5%) had AAA on Vscan®. Eleven out of 14 AAA-cases (78.6%) had AAA on confirmatory imaging (one patient died). The total prevalence of AAA was 2.49% (95%CI 2.20 to 2.78). The median aortic diameter at diagnosis was 3.5 cm in screened patients and 4.7 cm (p<0.001) in patients in whom AAA was diagnosed incidentally. Multivariate logistic regression analysis identified coronary heart disease (OR = 4.6, 95%CI 1.3 to 15.9) as the independent factor with the highest odds ratio. A screening program led by trained family physicians using hand-held ultrasound was a feasible, safe and reliable tool for the early detection of AAA.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Aorta, Abdominal / diagnostic imaging*
  • Aortic Aneurysm, Abdominal / diagnostic imaging*
  • Aortic Aneurysm, Abdominal / epidemiology
  • Coronary Disease / diagnostic imaging
  • Coronary Disease / epidemiology
  • Early Diagnosis
  • Feasibility Studies
  • Humans
  • Logistic Models
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Odds Ratio
  • Physicians, Family
  • Point-of-Care Testing*
  • Prevalence
  • Primary Health Care*
  • Prospective Studies
  • Risk Factors
  • Tomography, X-Ray Computed
  • Ultrasonography*