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. 2021 Jun 15;16(6):e0253327.
doi: 10.1371/journal.pone.0253327. eCollection 2021.

Modelling the impact of changes to abdominal aortic aneurysm screening and treatment services in England during the COVID-19 pandemic

Lois G Kim  1 , Michael J Sweeting  1   2 , Morag Armer  3 , Jo Jacomelli  3 , Akhtar Nasim  4 , Seamus C Harrison  1
Affiliations

Modelling the impact of changes to abdominal aortic aneurysm screening and treatment services in England during the COVID-19 pandemic

Lois G Kim et al. PLoS One. .

Abstract

Background: The National Health Service (NHS) abdominal aortic aneurysm (AAA) screening programme (NAAASP) in England screens 65-year-old men. The programme monitors those with an aneurysm, and early intervention for large aneurysms reduces ruptures and AAA-related mortality. AAA screening services have been disrupted following COVID-19 but it is not known how this may impact AAA-related mortality, or where efforts should be focussed as services resume.

Methods: We repurposed a previously validated discrete event simulation model to investigate the impact of COVID-19-related service disruption on key outcomes. This model was used to explore the impact of delayed invitation and reduced attendance in men invited to screening. Additionally, we investigated the impact of temporarily suspending scans, increasing the threshold for elective surgery to 7cm and increasing drop-out in the AAA cohort under surveillance, using data from NAAASP to inform the population.

Findings: Delaying invitation to primary screening up to two years had little impact on key outcomes whereas a 10% reduction in attendance could lead to a 2% lifetime increase in AAA-related deaths. In surveillance patients, a 1-year suspension of surveillance or increase in the elective threshold resulted in a 0.4% increase in excess AAA-related deaths (8% in those 5-5.4cm at the start). Longer suspensions or a doubling of drop-out from surveillance would have a pronounced impact on outcomes.

Interpretation: Efforts should be directed towards encouraging men to attend AAA screening service appointments post-COVID-19. Those with AAAs on surveillance should be prioritised as the screening programme resumes, as changes to these services beyond one year are likely to have a larger impact on surgical burden and AAA-related mortality.

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Conflict of interest statement

No authors have competing interests.

Figures

Fig 1
Fig 1. 65-year-old cohort: Change in key outcomes over varying delay to primary invitation (model I1).
Fig 2
Fig 2. 65-year-old cohort: Change in key outcomes over varying attendance at primary scan (model I2).
Fig 3
Fig 3. Surveillance cohort: Change in key outcomes over varying suspension of surveillance scans (model S1).
Fig 4
Fig 4. Surveillance cohort: Change in key outcomes over varying dropout rates, applied for (i) 1y (model I2.1) and (ii) 2y (model I2.2).
Fig 5
Fig 5. Surveillance cohort: Change in key outcomes over varying time at increased (7cm) threshold (model I3).
See this image and copyright information in PMC

References

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    1. England NHS and Improvement NHS. NHS public health functions agreement 2019–20. Service specification No. 23. NHS Abdominal Aortic Aneurysm Screening Programme. 2019.
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    1. National Joint Vascular Implementation Board. COVID-19 response: Guidance on resumption of vascular surgery. 2020.

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