Document Detail

Probabilities of progression of aortic aneurysms: estimates and implications for screening policy.
MedLine Citation:
PMID:  11943797     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Screening for abdominal aortic aneurysm, and intervention with elective repair, can reduce the incidence of aneurysmal rupture by a half. If a screening programme is implemented, it is essential to determine appropriate follow up intervals for rescreening. This paper estimates probabilities of progression growth of aortic diameter to provide evidence for this. METHODS: Data were taken from 2342 men aged 65-80 screened in the Chichester randomised control trial, who have been followed up for an average of 11 years. Aortic diameter was modelled as a Markov process with four categories: <30 mm (normal), 30-44 mm, 45-54 mm, and > or =55 mm. Estimates of the probabilities of progressing to each higher category were obtained. RESULTS: The probabilities of progression increased with greater initial aortic diameter. The estimated rates/year were 0.018 (95% confidence interval 0.014 to 0.023), 0.16 (0.12 to 0.20), and 0.49 (0.35 to 0.70) respectively for moving up one category. The probabilities of moving from <30 mm to > or =55 mm were estimated as 1% in 5 years and 12% in 15 years, while the corresponding figures for moving from 45-54 mm to > or =55 mm were 91% and 99%. There were differences in rates of progression according to age, with men over 70 years having rates about three times those of men under 70. CONCLUSIONS: It seems unnecessary to follow up men with normal aortic diameter as they experience a low probability of reaching criteria for surgery even within 15 years. However, follow up intervals should be progressively shorter for those with greater aortic diameter, especially in those aged over 70. Active follow up, for example every 3 months, is appropriate for men with an aortic diameter of 45-54 mm.
E Couto; S W Duffy; H A Ashton; N M Walker; J P Myles; R A P Scott; S G Thompson
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Publication Detail:
Type:  Clinical Trial; Journal Article; Randomized Controlled Trial    
Journal Detail:
Title:  Journal of medical screening     Volume:  9     ISSN:  0969-1413     ISO Abbreviation:  J Med Screen     Publication Date:  2002  
Date Detail:
Created Date:  2002-04-10     Completed Date:  2002-10-03     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  9433359     Medline TA:  J Med Screen     Country:  England    
Other Details:
Languages:  eng     Pagination:  40-2     Citation Subset:  IM    
MRC Biostatistics Unit, Institute of Public Health, Robinson Way, Cambridge CB2 2SR, UK.
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MeSH Terms
Aged, 80 and over
Aorta / pathology
Aortic Aneurysm, Abdominal / diagnosis,  pathology*
Disease Progression
Follow-Up Studies
Markov Chains

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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