Community-Based Screening and the Detection of Critical Carotid Artery Stenosis and Abdominal Aortic Aneurysm

Steven M. Weisman¹, Nathalie I. Garbani², Andrew J. Manganaro²

¹Innovative Science Solutions, Morristown, USA.
²Life Line Screening (LLS), Independence, USA.

DOI: 10.4236/ojpm.2015.52005                

Abstract

Background: Community-based cardiovascular screening has the opportunity to detect critical cardiovascular disease and positively affect public health outcomes. Disease deemed to be critical or severe at detection requires appropriate medical follow-up. This article examined the self-reported outcomes of individuals who had undergone community-based cardiovascular screening and had critical findings for abdominal aortic aneurysm (AAA) or carotid artery stenosis (CAS). Methods: Over 390,000 screening records for AAA and over 490,000 screening records for CAS were reviewed to identify individuals with critical screening findings. A critical AAA is defined as an aneurysm ≥ 5cm and critical CAS is defined as a hemodynamically significant stenosis with recorded peak systolic velocities of ≥300 cm/s, in this population. Identified individuals were then contacted via phone and surveyed about the medical care they received after their screening. Results: Review of the screening records found a prevalence of critical AAA findings of 0.037% (146 participants) and critical CAS findings of 0.12% (579 participants). 61% of participants with critical findings were reached for follow-up from both groups. Over 96% of participants with critical AAA and over 92% of participants with critical CAS had some forms of medical follow-up. Conclusions: Community-based cardiovascular screening has the ability to detect critical levels of disease. Findings of critical disease in the reviewed population are similar to the findings from previously published studies. Importantly, medical treatment received by those who seek follow-up appears to be consistent with recommended treatment guidelines. Identification and management of critical disease represent meaningful public and individual health benefits and the possibility of cost-savings.

Keywords

Cardiovascular, Screening, Carotid Artery Stenosis, Abdominal Aortic Aneursym

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	Weisman, S.M. and Manganaro, A.J. (2013) Community-Based Screening: Identifying Risk and Motivating Healthy Lifestyle Changes. Postgraduate Medicine, 125. http://dx.doi.org/10.3810/pgm.2013.07.2675
[2]	Chang, Y.J., Golby, A.J. and Albers, G.W. (1995) Detection of Carotid Stenosis. From NASCET Results to Clinical practice. Stroke, 26, 1325-1328. http://dx.doi.org/10.1161/01.STR.26.8.1325
[3]	USA Preventive Services Task Force (2007) Screening for Carotid Artery Stenosis: USA Preventive Services Task Force Recommendation Statement. Annals of Internal Medicine, 147, 854-859. http://dx.doi.org/10.7326/0003-4819-147-12-200712180-00005
[4]	USA Preventive Services Task Force (2005) Screening for Abdominal Aortic Aneurysm: Recommendation Statement. AHRQ Publication No. 05-0569-A.
[5]	deWeerd, M., Greving, J.P., Hedblad, B., et al. (2010) Prevalence of Asymptomatic Carotid Artery Stenosis in the General Population: An Individual Participant Data Meta-Analysis. Stroke, 41, 1294-1297. http://dx.doi.org/10.1161/STROKEAHA.110.581058
[6]	deWeerd, M., Greving, J.P., Hedblad, B., et al. (2014) Prediction of Asymptomatic Carotid Artery Stenosis in the General Population: Identification of High Risk Groups. Stroke, 45, 2366-2371. http://dx.doi.org/10.1161/STROKEAHA.114.005145
[7]	O’Leary, D.H., Polak, J.F., Kronmal, R.A., Kittner, S.J., Bond, M.G., Wolfson Jr., S.K., et al. (1992) Distribution and Correlates of Sonographically Detected Carotid Artery Disease in the Cardiovascular Health Study. The CHS Collaborative Research Group. Stroke, 23, 1752-1760. http://dx.doi.org/10.1161/01.STR.23.12.1752
[8]	Jacobowitz, G.R., Rockman, C.B., Gagne, P.J., et al. (2003) A Model for Predicting Occult Carotid Artery Stenosis: Screening Is Justified in a Selected Population. Journal of Vascular Surgery, 38, 705-709. http://dx.doi.org/10.1016/S0741-5214(03)00730-4
[9]	Ricotta, J.J., Aburahma, A., Ascher, E., Eskandari, M., Faries, P. and Lal, B.K. (2011) Updated Society for Vascular Surgery Guidelines for Management of Extracranial Carotid Disease: Executive Summary. Journal of Vascular Surgery, 54, 832-836. http://dx.doi.org/10.1016/j.jvs.2011.07.004
[10]	Greco, G., Egorova, N.N., Gelijns, A.C., et al. (2010) Development of a Novel Scoring Tool for the Identification of Large ≥ 5 cm Abdominal Aortic Aneurysms. Annals of Surgery, 252, 675-682.
[11]	Kent, K.C., Zwolak, R.M., Egorova, N.N., et al. (2012) Analysis of Risk Factors for Abdominal Aortic Aneurysm in a Cohort of More than 3 Million Individuals. Journal of Vascular Surgery, 52, 539-548. http://dx.doi.org/10.1016/j.jvs.2010.05.090
[12]	Lederle, F.A., Johnson, G.R., Wilson, S.E., Chute, E.P., Hye, R.J., Makaroun, M.S., et al. (2000) The Aneurysm Detection and Management Study Screening Program: Validation Cohort and Final Results. Aneurysm Detection and Management Veterans Affairs Cooperative Study Investigators. Archives of Internal Medicine, 160, 1425-1430. http://dx.doi.org/10.1001/archinte.160.10.1425
[13]	Brewster, D.C., Cronenwett, J.L., Hallett Jr., J.W., Johnston, K.W., Krupski, W.C. and Matsumura, J.S., Joint Council of the American Association for Vascular Surgery and Society for Vascular Surgery (2003) Guidelines for the Treatment of Abdominal Aortic Aneurysms. Report of a Subcommittee of the Joint Council of the American Association for Vascular Surgery and Society for Vascular Surgery. Journal of Vascular Surgery, 37, 1106-1117. http://dx.doi.org/10.1067/mva.2003.363
[14]	Silverstein, M.D., Pitts, S.R., Chaikof, E.L. and Ballard, D.J. (2005) Abdominal Aortic Aneurysm (AAA): Cost-Effectiveness of Screening, Surveillance of Intermediate-Sized AAA, and Management of Symptomatic AAA. Proceedings (Baylor University. Medical Center), 18, 345-367.