Gaps In Screening Among Medicare Patients With A Ruptured Abdominal Aortic Aneurysm
Author(s)
Anne K. Marti, MS, Jeffrey D. Miller, MS;
W. L. Gore & Associates, Elkton, MD, USA
W. L. Gore & Associates, Elkton, MD, USA
OBJECTIVES: The mortality rate for patients experiencing ruptured abdominal aortic aneurysms (AAA) is high. Screening and subsequent monitoring via ultrasonography can identify AAAs before they rupture and potentially reduce mortality. Current United States Preventive Task Force (USPTF) guidelines recommend AAA screening in men aged 65 to 75 who have ever smoked. This analysis aims to identify gaps in AAA screening by analyzing patients with ruptured AAAs by screening history.
METHODS: The Medicare Fee-For-Service Limited Data Set 5% sample was used to identify patients with new ruptured AAA diagnoses between 2019 and 2023. Patients were required to have 3 years of continuous enrollment pre-index AAA rupture and no endovascular aortic repair (EVAR) procedure during baseline. Ultrasound and computed tomography (CT) codes were used to identify abdominal imaging in the 3 years to 1-day pre-index diagnosis date. Patient characteristics and health care utilization were analyzed, stratified by AAA screening history.
RESULTS: A total of 1,548 patients had an index ruptured AAA, of which 60.1% (N=931) had a history of abdominal ultrasound and another 18.5% (N=286) had a history of abdominal CT scan alone. The remaining 21.4% (N=331) of patients had no evidence of abdominal ultrasound or CT scan pre-rupture. 30-day mortality was highest in patients with no history of abdominal imaging (N=65, 19.6%) and lowest in those with a history of ultrasound only (N=20, 8%). Patients with no abdominal imaging had a median of 11 office/clinic encounters in the 3 years pre-rupture. A total of 13.24% (N=205) of all patients received an EVAR in the 30 days post-rupture.
CONCLUSIONS: A large proportion of ruptured AAA patients had no recent history of AAA screening, despite regular interactions with the health care system. Provider education around AAA screening may help improve screening rates and potentially reduce ruptured AAA patient mortality.
METHODS: The Medicare Fee-For-Service Limited Data Set 5% sample was used to identify patients with new ruptured AAA diagnoses between 2019 and 2023. Patients were required to have 3 years of continuous enrollment pre-index AAA rupture and no endovascular aortic repair (EVAR) procedure during baseline. Ultrasound and computed tomography (CT) codes were used to identify abdominal imaging in the 3 years to 1-day pre-index diagnosis date. Patient characteristics and health care utilization were analyzed, stratified by AAA screening history.
RESULTS: A total of 1,548 patients had an index ruptured AAA, of which 60.1% (N=931) had a history of abdominal ultrasound and another 18.5% (N=286) had a history of abdominal CT scan alone. The remaining 21.4% (N=331) of patients had no evidence of abdominal ultrasound or CT scan pre-rupture. 30-day mortality was highest in patients with no history of abdominal imaging (N=65, 19.6%) and lowest in those with a history of ultrasound only (N=20, 8%). Patients with no abdominal imaging had a median of 11 office/clinic encounters in the 3 years pre-rupture. A total of 13.24% (N=205) of all patients received an EVAR in the 30 days post-rupture.
CONCLUSIONS: A large proportion of ruptured AAA patients had no recent history of AAA screening, despite regular interactions with the health care system. Provider education around AAA screening may help improve screening rates and potentially reduce ruptured AAA patient mortality.
Conference/Value in Health Info
2025-05, ISPOR 2025, Montréal, Quebec, CA
Value in Health, Volume 28, Issue S1
Code
HSD3
Topic
Health Service Delivery & Process of Care
Disease
SDC: Cardiovascular Disorders (including MI, Stroke, Circulatory)