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Screening for AAA in Sweden vs. Finland
Quick Takes
- Perioperative morbidity and mortality are lower for intact AAA repair as compared to ruptured AAA repair.
- Rates of surgery for intact AAA increased in Sweden following a nationwide AAA screening program but declined in Finland without a screening program.
- Perioperative mortality improved at a greater rate in Sweden than Finland, likely related to the nationwide AAA screening program in Sweden.
Study Questions:
What is the difference in incidence and repair of abdominal aortic aneurysms (AAAs) between countries with different screening practices?
Methods:
The authors conducted an analysis of AAA repair between 1998 and 2017 in Finland and Sweden. Both countries have similar populations and health care systems, but only Sweden has routine AAA screening for all men aged ≥65 years. Rates of surgery for intact versus ruptured AAA and perioperative mortality data were compared.
Results:
A total of 15,927 AAA operations were performed in Sweden, while 6,933 AAA surgeries were performed in Finland during the 20-year period. Rates of surgery for intact AAA increased in Sweden (72.8 [70.2-75.5] to 84.0 [81.9-86.1] per 100,000 person-years) but declined in Finland (68.1 [64.6-71.8] to 60.1 [57.8-62.5] per 100,000 person-years) from before to after AAA screening was initiated in Sweden. Both countries had a decline in rates of surgery for ruptured AAA, but the decrease was more pronounced in Sweden (24.1 [23.2-25.0] to 14.8 [14.2-15.3] per 100,000 person-years) as compared to Finland (11.7 [10.9-12.6] to 9.7 [9.1-10.2] per 100,000 person-years). Long-term survival improved for men aged 65-79 years in Sweden after the start of routine AAA screening.
Conclusions:
The authors conclude that a universal AAA screening program for men aged ≥65 years old in Sweden was associated with a decrease in the rate of surgery for ruptured AAA, increase in the rate of surgery for intact AAA, and improved mortality.
Perspective:
It is well established that the perioperative morbidity and mortality is significantly higher for patients undergoing surgery for a ruptured AAA as compared to an intact AAA. However, this study presents some of the strongest population-level evidence about the benefits of a nationwide AAA screening program. Although the rate of surgical AAA repair was already higher in Sweden as compared to Finland, the shifts in the rate of intact versus ruptured AAA repair were notably different between the two countries. Most importantly, the rate of perioperative mortality declined at a greater rate in Sweden than Finland, likely related to the shift in intact versus ruptured AAA distribution influenced by the nationwide AAA screening program in Sweden.
Clinical Topics: Invasive Cardiovascular Angiography and Intervention, Vascular Medicine, Interventions and Vascular Medicine
Keywords: Aortic Aneurysm, Abdominal, Diagnostic Screening Programs, Vascular Surgical Procedures
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