Screening for Abdominal Aortic Aneurysm

1. Screening for Abdominal Aortic Aneurysm 6.10.10 Screening for abdominal aortic aneurysm Presenter: Dr Rosemary Fox Acting Director, Screening Division

2. Screening ‘a public health service in which people who do not necessarily perceive themselves to be at risk of, or affected by, a disease or its complications are asked a question or offered a test to identify those individuals who are more likely to be helped than harmed by further tests or treatment to reduce the risk of disease or its complications.’ Screening for abdominal aortic aneurysm

3. Screening Policy • UK NSC advises Ministers in UK home nations • Assesses proposed screening programmes against criteria • The condition • The test • The programme • Cost-effectiveness Screening for abdominal aortic aneurysm

4. Abdominal Aortic Aneurysm (AAA) • Swelling of aorta • 6x commoner in men than women • Commoner with increasing age • Usually asymptomatic until rupture Screening for abdominal aortic aneurysm

5. Ruptured AAA • Responsible for 2.5% deaths in men aged 65+ • 532 deaths in Wales, 2006 • 286 deaths in men aged 65+ • Overall mortality ruptured AAA: 85% Screening for abdominal aortic aneurysm

6. Screening for AAA • Abdominal ultrasound of 65 year old men • No aneurysm: discharge • Small aneurysm: repeat scan annually • Moderate aneurysm: repeat scan every three months • Large aneurysm: refer to vascular surgeon for elective repair Screening for abdominal aortic aneurysm

7. Screening: evidence • Clinically effective: RCT evidence of 48% reduction in mortality • Cost effective: £8,000 per life year saved at 10 years • Highly acceptable: uptake 80% in RCTs Screening for abdominal aortic aneurysm

8. What’s the catch? • Elective AAA repair has a 30 day mortality of 5% • Informed consent crucial • High quality surgical services- aim to reduce elective surgical mortality to 3.5% by 2013 Screening for abdominal aortic aneurysm

9. Other UK countries • England currently rolling out screening geographically- full implementation 2013 • Scotland and Northern Ireland planning to rollout their programmes 2011 Screening for abdominal aortic aneurysm

10. The programme: screening • Planning just started- we need to: • Identify and invite eligible population • Develop high quality information for potential participants • Procure and quality assure equipment • Train and quality assure screeners • Identify sites for screening and surveillance • Establish referral pathways for surgery Screening for abdominal aortic aneurysm

11. The programme: surgery • Establish referral pathways for surgery • Quality assure treatment services • Minimise mortality in participants • Evaluate the programme: • to demonstrate balance of good and harm • provide data to UK audits Screening for abdominal aortic aneurysm

12. Progress so far • Project established • Project board • Project team and subgroups • Workplans being developed • Recruitment of clinical lead and programme lead underway Screening for abdominal aortic aneurysm

13. Project structure Screening for abdominal aortic aneurysm

14. Major tasks for project • Identify screening model • Develop IT for call/recall, failsafe, evaluation • Develop training for and recruit screeners • Develop vascular surgical networks to national standards and identify referral pathways • Develop decision aids for potential participants • Produce costed implementation plan Screening for abdominal aortic aneurysm

15. Thank you…. • Any questions? Screening for abdominal aortic aneurysm