AUSÊNCIA DE SINTOMAS NÃO REPRESENTA RASTREIE PELA A AUSÊNCIA VIDA DE DOENÇA

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1 A DE SINTOMAS NÃO REPRESENTA DE DOENÇA RASTREIE PELA SUA VIDA

2 AAA Sreening in Portugal Armando Mansilha MD, PhD, FEBVS Paulo Sousa PhD Daniel Brandão MD, MMSc RASTREIO DO AAA EM PORTUGAL

3 Project Rationale Structure Divulgation Results RASTREIO DO AAA EM PORTUGAL

4 Project Rationale Silent Disease raaa Mortality Rate 80%-90% Screening by a simple method easily available Screening not included in SNS routine RASTREIO DO AAA EM PORTUGAL l PROJECT RATIONALE

5 Evidence RANDOMISED TRIALS CHICHESTER TRIAL - VIBORG TRIAL WESTERN AUSTRALIA TRIAL - MASS TRIAL TABLE 3 THE PREVALENCE OF AAA DETECTED BY POPULATION SCREENING Study Location Chichester, UK 16 Viborg, Denmark17 Western Australia18 Mass UK19 Rotterdam Netherlands20 Tromsø Norway21 N 15,775 12,628 41,000 67, Gender Men & Women Men Men Men Men & women Men & women Age ( years) > Sampling dates Date published Aneurism Prevalence 4,0% (7.6% in men, 1.3% in women 4.0% 7,2% 4,9% 4,1% men, 0,7% women 8,9% men, 2,2% women Moll et al; Management of Abdominal Aortic Aneurysms Clinical Practice Guidelines of the European Society for Vascular Surgery. Eur J Vasc Endovasc 2011; 41: S1

6 TABLE 5 SUMMARY OF THE POPULATION-BASED RANDOMISED SCREENING TRIALS TRIAL CARACTERISTICS Chichester, UK 16 Viborg, Denmark 17 Mass UK 101C Western Australia 18 NUMBER RANDOMISED 15,775 12,628 67,800 41,000 GENDER Men & Women Men Men Men AGE (YEARS) DATES RECRUITED DATE PUBLISHED % ACCEPTING SCREENING 68% 76% 80% 70% d ANEURYSM FOUND 4% (7,6% in men) 4% 4,9% 7,2% PLACE OF SCREENING HOSPITAL HOSPITAL COMMUNITY COMMUNITY INTERVENTION POLICY At 6 cm AT 5 CM At 5.5 cm measured as internal diameter MEAN FOLLOW-UP (MONTHS) 30, AAA MORTALITY 0,59 Men Only 0,31 0,58 0,72 ODDS RATIO SCREENED (0,27 1,29) (0,13 0,79) (0,42 0,78) (0,39-1,32) VS NOT (95%CI) a ALL-CAUSE MORTALITY ODDS MEN ONLY 1,07 RATIO SCREENED VS NOT (95%CI) b (0,93 1,22) OTHER OUTCOMES REPORTED no aneurysm-related mortality benefits in women Hospital deaths Costs Quality of life 0,97 (0,93 1,02) Quality of life Costs Workload None 0,98 (0,91-1,04) a Moll et al; Management of Abdominal Aortic Aneurysms Clinical Practice Guidelines of the European Society for Vascular Surgery. Eur J Vasc Endovasc 2011; 41: S1 b Pooled odds ratio trend in favour of screening, OR 0.98 (0.95 1,02). c The MASS trial recently has published 10-year follow up, demonstrating the cost-effectiveness ofscreening and a significant all-cause mortality benefit but a rising incidence of AAA rupture in the screened group. d As percentage of those alive when invitation for screening was sent: randomisation predated this invitation by several months in a large sector of subjects

7 Evidence cost-efectiveness 1. Analysis of cost effectiveness of screening Danish men aged 65 for abdominal aortic aneurysm. BMJ, Decision-analytical model with lifetime estimation of costs and health outcomes for one-time screening for abdominal aortic aneurysm in 65-year-old men. British Journal of Surgery, Aug Multicentre aneurysm screening study (MASS): cost effectiveness analysis of screening for abdominal aortic aneurysms based on four year results from randomised controlled trial. BMJ, Nov The cost-effectiveness of a "quick-screen" program for abdominal aortic aneurysms. Surgery, Aug Long-term benefit and cost-effectiveness analysis of screening for abdominal aortic aneurysms from a randomized controlled trial. British Journal of Surgery, Jun An economic evaluation of an abdominal aortic aneurysm screening program in Italy, Journal of Vascular Surgery Evidence for the credibility of health economic models for health policy decision-making: a systematic literature review of screening for abdominal aortic aneurysms, Journal of Health Services Research and Policy, Jan 2012

8 UK National Screening Programme RASTREIO DO AAA EM PORTUGAL NATIONAL SCREENING PROGRAMME

9 = 65A (automatic invitation) > 65A (self-referral) INITIAL RESULTS screenings 973 small AAA 89 large AAA 1,8% UK National Screening Programme RASTREIO DO AAA EM PORTUGAL NATIONAL SCREENING PROGRAMME

10 As a result the Portuguese Society for Angiology and Vascular Surgery has launched a unique project at national scale. The aim is to reduce deaths related to AAA rupture through a timely screening RASTREIO DO AAA EM PORTUGAL PROJETO

11 Target Male > 65 years Smoking history Hypetension High cholesterol levels Cardiovascular disease AAA family history Population RASTREIO DO AAA EM PORTUGAL POPULAÇÃO ALVO

12 Mobile Unit RASTREIO DO AAA EM PORTUGAL COMO ESTÁ ESTRUTURADO O RASTREIO

13 UNIT CIRCUIT Questionnaire filling BP measurement Abdominal US RASTREIO DO AAA EM PORTUGAL COMO ESTÁ ESTRUTURADO O RASTREIO

14 What were the possible results? Normal Small Aneurysm Large Aneurysm This means that the aorta is not enlarged (there is no aneurysm). No treatment or specific follow-up are required. This means that the aorta is slightly bigger than the normal. In these circumstances, you will be sent to your general practitioner that will provide adequate follow-up. This means that the aorta is much bigger than the normal. Only a small number of individuals will have this result. In these circumstances, you will adequately be sent for a possible surgical treatment. This will be accomplished by your general practitioner that will sent you for an Angiology and Vascular Surgery Department according to your residence. RASTREIO DO AAA EM PORTUGAL COMO ESTÁ ESTRUTURADO O RASTREIO

15 Information note to the General Practitioner envelope papel de carta RASTREIO DO AAA EM PORTUGAL COMO ESTÁ ESTRUTURADO O RASTREIO

16 A DE SINTOMAS NÃO REPRESENTA DE DOENÇA RASTREIO DO AAA EM PORTUGAL DIVULGAÇÃO E MEDIATIZAÇÃO - SLOGAN

17 RASTREIO DO AAA EM PORTUGAL DIVULGAÇÃO E MEDIATIZAÇÃO - CARTAZ

18 RASTREIO DO AAA EM PORTUGAL DIVULGAÇÃO E MEDIATIZAÇÃO - FOLHETO INFORMATIVO

19 web A webpage was created in Facebook project A address was offered for those interested in an anticipated inscription. Inscriptions on site were also available. RASTREIO DO AAA EM PORTUGAL DIVULGAÇÃO E MEDIATIZAÇÃO - PROJETO NA WEB

20 Project in the web SPACV_website RASTREIO DO AAA EM PORTUGAL DIVULGAÇÃO E MEDIATIZAÇÃO - PROJETO NA WEB

21 Project in the web facebook RASTREIO DO AAA EM PORTUGAL DIVULGAÇÃO E MEDIATIZAÇÃO - PROJETO NA WEB

22 Information to the ARS, local health centres, municipal councils, parish councils, RASTREIO DO AAA EM PORTUGAL DIVULGAÇÃO E MEDIATIZAÇÃO

23 Local and National Press RASTREIO DO AAA EM PORTUGAL DIVULGAÇÃO E MEDIATIZAÇÃO

Press conference 06/16/2012 PRESS TVI Antena 1 Notícias Médicas Agência Lusa Expresso

Rádio Nova JN Expresso online Primeiro de Janeiro Agência Lusa Semana Médica Correio

Rádio RCS RCM Pharma Notícias Médicas Norte Médico Portal Cidade de Viseu Gazeta de

24 Press conference 06/16/2012 PRESS TVI Antena 1 Notícias Médicas Agência Lusa Expresso Canal UP Norte Médico News generated TVI Porto Canal - Programa Consultório Antena 1 Rádio Nova JN Expresso online Primeiro de Janeiro Agência Lusa Semana Médica Correio da Manhã RTP online Mundo Universitário Jornalismo Porto Net Portugal Centro Notícias Rádio RCS RCM Pharma Notícias Médicas Norte Médico Portal Cidade de Viseu Gazeta de Viseu Canal UP Portal Viva Agenda RASTREIO DO AAA EM PORTUGAL DIVULGAÇÃO E MEDIATIZAÇÃO

25 Results DISTRICT DISTRIBUTION CIDADE TOTAIS RASTREIOS RASTREIO DO AAA EM PORTUGAL RESULTADOS n com aorta >=3,0 cm DIÂMETRO Aveiro ,06 Beja 79 2 Braga 49 0 Bragança 91 2 Castelo Branco Coimbra ,0 4,78 5,0 3,7 3,34 3,07 4,67 3,80 4,27 Évora ,4 Faro ,1 Funchal 74 2 Guarda 58 3 Leiria 70 3 Lisboa 40 3 Ponta Delgada 90 3 Portalegre 47 0 Porto Santarém Setúbal 92 4 Viana do Castelo ,29 3,57 3,1 3,2 3,65 3,78 3,19 3,57 3,2 4,23 6,7 3,1 3,4 4,1 3,54 3,47 3,1 3,6 3,5 3,2 3,4 3,1 5,0 3,4 Vila Real ,4 Viseu ,7 LISBOA 40 VIANA DO CASTELO 92 LEIRIA 70 BRAGA 49 PORTO 136 AVEIRO 68 COIMBRA 86 SANTARÉM 138 SETÚBAL 92 AÇORES PONTA DELGADA 90 VILA REAL 62 VISEU 69 GUARDA 58 CASTELO BRANCO 112 PORTALEGRE 47 ÉVORA 70 BEJA 79 FARO 81 BRAGANÇA 91 MADEIRA FUNCHAL 74

26 Results SCREENING PERIOD: JUNE 2011 TO MARCH 2012 DISTRICT CAPITALS COVERED: 20 (THE WHOLE COUNTRY) TOTAL NUMBER OF INDIVIDUALS SCREENED: 1604 NUMBER OF SMALL ANEURYSMS DETECTED: 34 NUMBER OF LARGE ANEURYSMS DETECTED (> 5 CM): 4 TOTAL NUMBER OF DETECTED ANEURYSMS: 38 (2.37%) RASTREIO DO AAA EM PORTUGAL RESULTADOS

27 AAA RISK FACTORS RESULTS DEMOGRAPHIC DATA ALL MALE AGE MEAN: 73.5 [65-95 YO] TOBACCO CURRENTLY SMOKERS: 7,9% PAST SMOKERS: 43,9% HYPERTENSION: 60,6% HYPERCHOLESTEROLEMIA: 46% ASSOCIATED DISEASES CORONARY DISEASE: 17% CEREBROVASCULAR DISEASE: 7,8% RASTREIO DO AAA EM PORTUGAL RESULTADOS

28 LIMITATIONS SELECTION BIAS INDIVIDUALS RECRUITED SELF-REFERENTIAL INDIVIDUALS INFORMED ABOUT THE CAMPAIGN PATIENTS CONCERNED ABOUT HEALTH ARE THE ONES THAT MAY HAVE ADHERED THE MOST SCREENED POPULATION POSSIBLY NOT FULLY REPRESENTATIVE OF THE >65 YO PORTUGUESE POPULATION. RASTREIO DO AAA EM PORTUGAL LIMITAÇÕES

29 CONCLUSIONS - ABDOMINAL AORTIC ANEURYSM SIGNIFICANT REDUCTION IN MORTALITY ASSOCIATED WITH AAA REDUCED INCIDENCE OF AAA RUPTURE INCREASED LIFE EXPECTANCY OF INDIVIDUALS SCREENED SCREENING PROGRAM TO PROPOSE TO THE MINISTRY OF HEALTH TO CARRY OUT A NATIONAL SCREENING PROGRAM FOR AAA INTEGRATED IN THE NATIONAL PLAN OF HEALTH RASTREIO DO AAA EM PORTUGAL CONCLUSÕES

30 A DE SINTOMAS NÃO REPRESENTA DE DOENÇA RASTREIE PELA SUA VIDA

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