[Screening of abdominal aortic aneurysm in primary care]

Introduction: The prevalence of abdominal aortic aneurysm in Hungary is not precisely known, but given the similar (or slightly worse) prevalence of cardiovascular disease comparing to the Western countries, the estimated prevalence in the population over 65 years of age is expected to be between 1.3–3.3%, with a male predominance of 4 : 1. The gold standard screening method for this condition is the B-mode ‘abdominal’ ultrasound scan. In our country, there is currently no institutionalized screening program for this disease, which is most probably due to the scarce human resources in the outpatient care. Despite the theoretical availability of the skill base and equipment, the nearly 400,000 people in this risk group can not be screened. Objective: Due to the governmental procurement to improve primary care, B-mode ultrasound machines are now available in one-sixth of general practices in Hungary (1,000 ultrasound machines). Hopefully in the near future further 500 machines will be made available resulting in ultrasound machines in one quarter of the practices, or one third of practice groups. Using a prospective observational approach, we aim to investigate whether abdominal aortic aneurysm screening of men over 65 years of age can be safely incorporated into the daily adult care. Our model is based on the premise that the population of over 65 attending at the general practice surgeries has a significant overlap with the risk group for abdominal aneurysm. Method: Based on the consensus of the Hungarian Society of Radiology and the College of General Practitioners, we have prepared/conducted a bedside ultrasound educational course. Following accreditation, we trained 150 general practitioners and organized a skills test for the participants. A two-month pilot project was designed for 10 general practitioners who have passed the proficiency test and have a validated ultrasound machine. Examiners will perform focused abdominal aortic aneurysm screening of patients who meet the inclusion criteria in all morning/afternoon general practice surgeries in a crossover manner. Five practices would perform POCUS scans for one month either on a call-in basis (classical screening model) while in five practices only the ‘drop-in’ patients will be screened. The practices will swap in the next month. As a primary endpoint, we would look at the time spent in care, and thus patient safety, and as a secondary endpoint we would also measure provider’s resilience and patient satisfaction. Given the relatively low number of participants, the secondary endpoints will not include prevalence of the abdominal aortic aneurysm. Results: Our research is novel, no previous studies compared call-in and drop-in screening models of abdominal aneurysm in primary care. Discussion: If in our model the organized screening does not result in significantly higher adherence (higher number of examinations) than the so-called ‘drop-in’ model can easily be incorporated into the routine of practice without compromising patient safety. Furthermore, we can investigate the effects of general practitioners based abdominal aorta screening on provider resilience and patient satisfaction, too. Conclusions: We hope that the national economic gains of the potentially screened/saved lives, the obvious improvement of general practitioner skill sets and the expected positive patient experience can justify the resources invested. Orv Hetil. 2024; 165(34): 1332–1339.