Abdominal Aortic Aneurysm: Aspects on how to affect mortality from rupture

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Hager, Jakob,1967-Linköpings universitet,Östergötlands Läns Landsting,Thorax-kärlkliniken i Östergötland,Avdelningen för kardiovaskulär medicin,Hälsouniversitetet (författare)

Abdominal Aortic Aneurysm : Aspects on how to affect mortality from rupture

BokEngelska2014

Förlag, utgivningsår, omfång ...

2014-01-08
Linköping :Linköping University Electronic Press,2014
113 s.
electronicrdacarrier

Nummerbeteckningar

LIBRIS-ID:oai:DiVA.org:liu-102482
ISBN:9789175195032
https://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-102482URI
https://doi.org/10.3384/diss.diva-102482DOI

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Språk:engelska
Sammanfattning på:engelska

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Ämneskategori:vet swepub-contenttype
Ämneskategori:dok swepub-publicationtype

Anmärkningar

Abdominal Aortic Aneurysm (AAA) is a disease that mainly affects elderly men, and ruptured AAA (rAAA) is associated with a mortality of > 80%. AAA seldom gives any symptoms prior to rupture.The aims of this thesis were to investigate different aspects of how to affect mortality from rAAA.In Study I, we identified 849 patients treated for rAAA during 1987-2004, and studied the 30-day survival after surgery, depending on whether they came directly to the treating hospital (one-stop) or were transferred via another hospital (two-stop). A two-stop referral pattern resulted in a 27% lower population-based survival rate for patients 65-74 years of age. However, the consequences would be small even if a one-stop referral pattern could be generally accomplished, due to the huge over-all mortality related to rAAA, hence an argument to find and treat AAA before rupture, e.g. by screening.In Study II, we examined the AAA-prevalence and the risk factors for AAA among 70-year-old men. The screening-detected AAA-prevalence was 2.3%, thus less than half the predicted. The most important risk factor was smoking.In Study III, we compared the screening-detected AAA-prevalence, the attendance rate, and the rate of opportunistic detection of AAA, between almost 8000 65- and 6000 70-year-old men. There was no difference in the screening-detected prevalence; probably due to the fact that almost 40% of the AAAs among the 70-year-old were already known prior to screening, compared to roughly 25% in the 65-year-old. The attendance rate was higher among the 65-year-old men, 85.7% compared 84.0% in the 70-year-old. Thus, there is no benefit of screening for AAA among 70- instead of 65-year-old men.In Study IV, a cost-effectiveness analysis, we found that screening for AAA still appears to be cost-effective, despite profound changes in disease pattern and AAA-management.In conclusion, we found that mortality from rAAA is not affected in any substantial way by different referral patterns and hence centralisation of services for AAA/rAAA is not a solution. A better alternative is to prevent rupture through early detection by screening. Screening 65-year-old men for AAA still appears to be cost-effective, despite profound changes in disease pattern and AAA-management during the last decade. Screening 70- instead of 65-year-old men will not increase the efficacy of screening.

Ämnesord och genrebeteckningar

MEDICIN OCH HÄLSOVETENSKAP Klinisk medicin Kirurgi hsv//swe
MEDICAL AND HEALTH SCIENCES Clinical Medicine Surgery hsv//eng
abdominal aortic aneurysm rupture AAA rAAA screening one-stop two stop prevalence risk factor cost-effectiveness

Biuppslag (personer, institutioner, konferenser, titlar ...)

Länne, Toste,ProfessorÖstergötlands Läns Landsting,Linköpings universitet,Avdelningen för kardiovaskulär medicin,Centrum för medicinsk bildvetenskap och visualisering, CMIV,Hälsouniversitetet,Thorax-kärlkliniken i Östergötland(Swepub:liu)tosla34 (preses)
Lundgren, Fredrik,Ph DÖstergötlands Läns Landsting,Linköpings universitet,Avdelningen för kardiovaskulär medicin,Hälsouniversitetet,Thorax-kärlkliniken i Östergötland(Swepub:liu)frelu24 (preses)
Carlsson, Per,ProfessorLinköpings universitet,Avdelningen för hälso- och sjukvårdsanalys,Hälsouniversitetet(Swepub:liu)perca23 (preses)
Wanhainen, Anders,DocentAkademiska Sjukhuset Uppsala (opponent)
Östergötlands Läns LandstingThorax-kärlkliniken i Östergötland (creator_code:org_t)

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