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Retrospective review of abdominal aortic aneurysm deaths in New Zealand: what proportion of deaths is potentially preventable by a screening programme in the contemporary setting?
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  • Published on:
    Comorbidities and opportunistic detection do not stop AAA screening from being cost-effective and equity enhancing.
    • Karen Bartholomew, Director of Health Outcomes Waitemata and Auckland District Health Boards
    • Other Contributors:
      • Dale Bramley, Chief Executive
      • Sue Crengle, Associate Professor – Māori Health
      • Corina Grey, Public Health Physician
      • Andrew Hill, Clinical Director of Auckland Regional Vascular Services
      • Greg Jones, Research Professor
      • Manar Khashram, Vascular Surgeon
      • Justin Roake, Professor of Surgery
      • Peter Sandiford, Public Health Physician / Honorary academic
      • Nina Scott, Clinical Director Māori Public Health

    The recently published article by Chan et al. questions the value of AAA screening. [1] We question the validity of the arguments and the data they use to support it, which we believe are either irrelevant or support the case for screening. Furthermore, the Chan et al. paper completely neglects the important equity gains that AAA screening can produce in the New Zealand (NZ) population.

    Chan and his co-authors’ critique of AAA screening is based on 3 arguments: (i) patients with AAA are too sick with other comorbidities to benefit from screening and die of these other illnesses; (ii) most patients with AAA would be diagnosed by the health system anyway without a screening programme; and (iii) the size of the population that can benefit from screening is too small for it to be cost effective. Let us look more closely at each of these.

    Co-morbidities in patients with AAA

    The authors emphasise the point that co-morbidities in AAA patients might limit the benefit they attain from screening. They calculate that 77% of those dying of AAA had some other comorbidity. However, to imply that these were fulminant conditions and that preventing AAA death in this group would have been futile because they are moribund is highly misleading. The collection of co-morbidities includes: atrial fibrillation (a condition very prevalent in any elderly population), cardiovascular disease (CVD), also highly prevalent especially for Māori (which could range in severity f...

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    Conflict of Interest:
    None declared.