Abstract 100: Clinical impact of United States Preventive Services Task Force screening recommendations for abdominal aortic aneurysm: Analysis of Nationwide Inpatient Sample data
Introduction: An abdominal aortic aneurysm (AAA) is defined when infra-renal aortic diameter is at least 3.0 cm. The United States Preventive Services Task Force recommended in 2005 that all men between the ages of 65 to 75 years who have ever smoked should be screened once for AAA by abdominal ultrasonography. However, the clinical impact of these recommendations are unknown.
Methods: We queried Healthcare Cost and Utilization Project’s Nationwide Inpatient Sample (NIS) data for AAA and AAA rupture using ICD9 codes 441.4 and 441.3 respectively. The NIS represents 20% of all hospitals data in the US. All the data was extracted for years 2000-2010. Total hospitalizations and in-hospital mortality for pre-screening years (2000-2004) was compared with post-screening years (2006-2010) for both AAA and AAA rupture.
Results: A total of 527,801 hospitalizations secondary to AAA and AAA rupture were analyzed for the study period.
Hospitalizations from AAA decreased from 61.72 to 58.77 per 10,000 total hospitalizations with in-hospital mortality decreasing from 3.5% to 2.12% (p value <0.001). On sub-analysis, the decrease in hospitalizations was significant in 65-84 age group (77.19 to 74.54 per 100 AAA admissions, p <0.001), with significant increase in 84+ age group (6.37 to 8.6 per 100 AAA admissions, p<0.001) and non-significant increase in 45-64 age group (16.16 to 16.51 per 100 AAA admissions, p value >0.05). Decrease in mortality was uniform in all age and gender sub-groups.
The hospitalizations from AAA rupture decreased from 9.51 to 7.03 per 10,000 total hospitalizations (p<0.001) with mortality decreasing from 49.9% to 44.6% (p value <0.001). On sub-analysis decrease in hospitalizations was reciprocated in 65-84 age group (70.08 to 64.94 per 100 AAA rupture admissions, p value <0.001) and males (73.23 to 71.7 per 100 AAA rupture admissions, p value <0.001). However, hospitalizations from AAA rupture increased in age group 45-64 (14.41 to 15.43 per 100 AAA rupture admissions, p value <0.001), age 84+ (15.21 to 19.2 per 100 AAA rupture admissions, p value < 0.001) and females (26.28 to 28.28 per 100 AAA rupture admissions, p value <0.001). In-hospital mortality from AAA rupture decreased in all age and gender sub-groups independently.
Conclusion: Our study reveals that post screening recommendations, hospitalizations for AAA decreased significantly in the age group 65-84 years. Also, hospitalizations from AAA rupture decreased in males and age group 65-84, with increase in other age sub groups (45-64 and 84+) and females. Thus, screening recommendations have resulted in decreased hospitalizations in specified age-gender subgroup likely from early recognition and better control of risk factors as outpatient. Our study also makes case to consider extension of recommendations to include other susceptible groups though prospective studies might be needed to support the data.
Author Disclosures: S. Aggarwal: None. D. Malik: None. M. Schauer: None.
- © 2014 by American Heart Association, Inc.