Prognosis in elderly men with screening-detected abdominal aortic aneurysm

• OBJECTIVES: To study the natural course of screening-detected symptomless abdominal aortic aneurysm (AAA) in elderly men. SETTING: Malmo, a city in southern Sweden with 230,000 inhabitants and a single referral hospital. MATERIALS: 423 seventy-four-year-old men, randomly selected from the population and belonging to the prospective population study "Men born in 1914", were invited. 343 underwent AAA screening, whereas 80 declined or had moved. CHIEF OUTCOME MEASURES: Five year all cause mortality in relation to participation in and findings at ultrasound screening for AAA. MAIN RESULTS: An abdominal aortic aneurysm was present in 38 (11%) out of 340 men who underwent screening and who had a native aorta. During 5 years of follow-up, one third (13/38) of these men died; 7 from myocardial infarction and 3 from stroke. The mortality rate in men with AAA was 80.2/1000 person years; twice as high as it was in men without AAA (39.4/1000 person years; p = 0.018). Six men underwent AAA surgery. None of them died from aneurysm rupture. However, aneurysm surgery did not reduce the total mortality rate in these men. The highest mortality rate, 91.9/1000 person years, was found in the men who did not participate in the screening. CONCLUSIONS: It is our conclusion that screening for early detection and intervention is of questionable value from a public health perspective.

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MEDICIN OCH HÄLSOVETENSKAP  -- Klinisk medicin -- Kirurgi (hsv//swe)

MEDICAL AND HEALTH SCIENCES  -- Clinical Medicine -- Surgery (hsv//eng)

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