Background: Abdominal aortic aneurysm (AAA), defined as aortic diameter ≥ 3.0 cm, affects an estimated 1.5% to 1.7% of men aged 65 or older. It was estimated that a ruptured AAA has a mortality rate of 75% – 90%. Screening for AAA with an abdominal ultrasound is relatively cost-effective. It was noted that screening for AAA in this subset of population provided a moderate benefit in decreasing AAA-related mortality with an absolute risk reduction of 0.14%. Hence, the USPSTF had recommended 1-time screening of AAA with ultrasound in men aged 65 – 75 years who have ever smoked. The aims of this study are to determine the patterns of AAA screening in an internal medicine resident-run clinic and to identify resident physician knowledge associated with AAA screening.
Methods: This is a retrospective chart review study of a total of 130 male patients, between the age of 65 to 75, who had visited our clinic over the period from July 2007 to July 2017. Inclusion criteria: Male patients, age 65 to 75 years, smoker, former smoker, and non-smoker. Exclusion criteria: Female, age <65 or >75 years, inactive status for ≥2 years or deceased. The data were collected and analyzed for the rates of the AAA screening in eligible patients, the rates of AAA screening ordered intentionally with abdominal ultrasound and incidentally with other imaging modality, and the rates of redundant screening. A survey consisting of 8 questions was distributed to 23 Internal Medicine resident physicians. We focused on assessing their understanding of AAA screening in accordance with the USPSTF recommendations.
Results: Out of 130 patients, only 112 (86.2%) patients met the study criteria. Of these 112 patients, 39.3% had never smoked, 42% were former smokers and 18.7% were active smokers. According to the USPSTF grade B recommendation, a total of 68 patients were eligible for AAA screening. Among the eligible patients, only 36.7% (25/68) were screened for AAA, whereby 64% (16/25) of them had AAA screening done by abdominal ultrasound and another 36% (9/25) had incidental AAA screening done by either CAT scan or MRI scan of the abdomen/pelvis. It was noted that 9 out of the 25 (36%) did not have their AAA screening result available in the outpatient EMR. In addition, 2 out of the 16 (12.5%) patients who had abdominal ultrasound done have had redundant AAA screening. Of the 23 completed surveys, 96% were aware of the USPSTF guidelines on AAA screening. However, only 43.5% had demonstrated sufficient familiarity with the AAA screening in accordance with the USPSTF recommendations.
Conclusions: In our study, we found that care gap – both knowledge and practice remained wide. It is inarguably that both domains must be addressed to improve the AAA screening rate in our clinic.