NHS GRAMPIAN, NHS ORKNEY & NHS SHETLAND COLLABORATIVE ABDOMINAL AORTIC ANEURYSM (AAA) SCREENING PROGRAMME ANNUAL REPORT OCTOBER 2012 TO OCTOBER 2013 Prepared by: Mrs Alison Mundie AAA Screening Programme Manager, Aberdeen Royal Infirmary NHS Grampian Executive Summary A national ‘Abdominal Aortic Aneurysm (AAA) Screening Programme’ was launched in Scotland in 2012. In the northeast of Scotland AAA-screening involves collaboration across NHS Grampian, NHS Orkney and NHS Shetland. Rollout within the collaborative commenced as a phased process across 11 sites in October 2012, with NHS Grampian being the third Health Board to begin screening in Scotland. Across the Collaborative AAA-screening is undertaken in urban, rural and island communities. The screening sites include the major mainland hospitals, community hospitals and island hospitals. AAA screening is undertaken by trained NHS nurses in Grampian/Orkney and by a Trainee Sonographer/Radiographer and Advanced Practitioner (Reporting Sonographer) in Shetland. Within the AAA-screening programme all men aged 65 are invited by postal invitation for an abdominal ultrasound scan to identify the presence of an AAA. Men with a normal abdominal aortic diameter (<3.0 cms) are discharged from the programme; men with a diameter between 3.0 to 5.4 cms are offered surveillance within the programme: and men with a diameter >= 5.5 cms are referred to the Vascular Surgery Unit at Aberdeen Royal Infirmary (ARI) for assessment (with a view to undergoing open repair or endovascular aneurysm repair, EVAR). Men over the age of 65 years, who have not previously been screened, are also able to self-refer themselves for AAA-screening. During the first year of AAA-screening across the Grampian-Orkney-Shetland Collaborative 6,021 men were offered screening and 87 men with AAA were identified (prevalence 1.4 per 1,000 men screened). Failure to measure aortic diameter was uncommon (1.3 per 1,000 men at first assessment). No adverse clinical incidents occurred during the first year of AAA-screening. Across the collaborative uptake among invited men was 88% (Grampian 89%; Orkney 82% and Shetland 84%). Only 218 self-referring men (aged > 65 years) were screened and these comprised 3.6% (218/6,021) of all men offered screening. In Grampian uptake was highest (91%) in the most affluent quintile and lowest (84%) in the most deprived quintile based on the Scottish Index of Multiple Deprivation (SIMD). Uptake of AAA-screening was highest among men living in small towns and rural areas; and lowest in men living in urban areas. Overall 78 men entered surveillance and 9 men were referred to vascular surgery at ARI. Of the 9 men referred to ARI, 8 (89%) were considered suitable for surgery. All 8 men survived surgery (4 open repair and 4 EVAR) and there were no deaths in the 30-days following surgery. Among these referrals 6/9 (67%) men received specialist assessment within 10 working days and 6/8 (75%) of those suitable for surgery were operated on within 40 working days. The ‘NHS Grampian-Orkney-Shetland’ Collaborative AAA-screening has achieved a high level of uptake (88%) during its first year of operation. The prevalence of AAA in the community (1.4%) is lower than anticipated (this has also been observed elsewhere and attributed to the sustained decline in the prevalence of smoking among men). In the next 12-months an assessment of the repeatability of aortic diameter measurements is being undertaken and a participant survey piloted. In order to offer participants a choice of suitable locations for AAA-screening the collaborative continues to monitor attendance and uptake rates across the multiple screening sites Data describing the ‘influence of rurality, deprivation and distance‐from‐clinic on the uptake by men of abdominal aortic aneurysm screening in Grampian’ was presented at the Scottish Faculty of Public Health Conference in Dunblane, Scotland (7 November 2013): http://www.fphscotconf.co.uk/uploads/FPH%202014%20Session%20D/alison_mundie.pdf THE GRAMPIAN COLLABORATIVE AAA SCREENING PROGRAMME ANNUAL REPORT 2012/2013 Final Version – 27 March 2015 Page 2 of 12 Programme Contacts NHS Grampian Collaborative Programme NHS Grampian Collaborative Clerical Assistant: Manager: Mrs Alison Mundie Miss Mhairi King Room 4.34, Ashgrove House Room 4.35, Ashgrove House Aberdeen Royal Infirmary Aberdeen Royal Infirmary Foresterhill Foresterhill Aberdeen Aberdeen Tel: 01224 553905 or 550825 Tel: 01224 553905 Email: [email protected] Key Personnel NHS Grampian Programme Co-ordinator: NHS Grampian Collaborative Clinical Lead: Dr Mike Crilly Mr Paul Bachoo Senior Lecturer in Clinical Epidemiology Vascular Clinical Lead and Consultant Vascular University of Aberdeen Medical School Surgeon Aberdeen Royal Infirmary NHS Shetland Programme Co-ordinator: NHS Orkney Programme Co-ordinator: Dr Susan Laidlaw Dr Kenneth Black Consultant in Public Health Medicine Consultant in Public Health Medicine Gilbert Bain Hospital, Lerwick Balfour Hospital, Kirkwall NHS Grampian & NHS Orkney Lead NHS Grampian & NHS Orkney Screening Nurses Sonographer: Mrs Penny Bruce Mrs Linda Sleigh Mrs Fiona Colvin Vascular Scientist Ms Wendy Geddes Aberdeen Royal Infirmary Miss Hazel Smart All based at Aberdeen Royal Infirmary NHS Shetland Lead Sonographer: NHS Shetland Sonographers: Lucy Wilson Lucy Wilson Radiographer/Sonographer Inga Tulloch Gilbert Bain Hospital, Lerwick Both based at Gilbert Bain Hospital, Lerwick Introduction This is the first Annual Report of the Grampian, Orkney and Shetland Collaborative Abdominal Aortic Aneurysm (AAA) Screening Programme which includes the 2012/13 screening population cohort. It should be noted that the Key Performance Indicators (KPI’s) referred to throughout this report are not officially in operation although we have benchmarked our figures against the anticipated KPI’s. The Grampian, Orkney and Shetland Collaborative were the third Board to launch the Programme in Scotland, on 25 October 2012. Using a phased approach the Grampian, Orkney and Shetland Collaborative completed the roll out of the Programme in May 2013. The National AAA Screening Programme commenced roll-out across Scotland in June 2012 and reached full national roll out in August 2013. The aim of the programme is to detect AAA’s early and monitor or treat them. This greatly reduces the chance of an aneurysm rupturing and causing serious problems. AAA (aortic diameter > 3 cm) is a relatively unknown condition across the general population. Aneurysms are commonest in men, and are associated with smoking, high cholesterol and high blood THE GRAMPIAN COLLABORATIVE AAA SCREENING PROGRAMME ANNUAL REPORT 2012/2013 Final Version – 27 March 2015 Page 3 of 12 pressure. AAA’s are often asymptomatic and the first sign of any problem will be when they rupture, which is often fatal. An invitation to attend for screening is sent to all men aged 65 and men aged 66 and over can self- refer. A scan will be taken using a portable ultrasound machine to measure the diameter of the aorta, the results of which are available to the participant at the point of testing. Depending on the result will dictate the pathway to be followed. Screening Outcomes Based on the results of the participants abdominal ultrasound scan they follow the appropriate pathway: Normal - Men with an AAA < 2.9 cm A normal result means that the aorta is not enlarged and there is no aneurysm. Men with a normal result are discharged from the Programme with no further recall as no treatment or monitoring is required. No further invites will be sent to the participant. The GP is not informed of the result. Small Aneurysm - Men with a small AAA > 3.0 cm - < 4.4 cm If a small aneurysm is found participants are monitored by the Programme and invited to return for a yearly surveillance scan. Medium Aneurysm - Men with a medium AAA > 4.5 cm to < 5.4 cm If a medium aneurysm is found participants are monitored by the Programme and invited to return for a quarterly surveillance scan. Large Aneurysm - Men with a large AAA > 5.5 cm If a large aneurysm is found participants are referred to Vascular Services for rapid surgical assessment and discussion of treatment options at Aberdeen Royal Infirmary. Detected early a large aneurysm may be repaired by elective surgery with lower associated mortality. Screening Locations The sites within Grampian used by the Programme during the year 2012/13 included: Hospitals: Aberdeen Royal Infirmary, Woodend (Aberdeen) and Dr Gray’s (Elgin) Community Hospitals: Aboyne, Chalmers (Banff), Jubilee (Huntly), Leanchoil (Forres), Kincardine (Stonehaven), Peterhead THE GRAMPIAN COLLABORATIVE AAA SCREENING PROGRAMME ANNUAL REPORT 2012/2013 Final Version – 27 March 2015 Page 4 of 12 Programme Performance Activity/Uptake 1. Invitation and Attendance National Screening Programme Key Performance Indicators for Invitation and Attendance Patient Topic Quality Measure Essential and Journey Desirable Criteria 1. Invitation CORE Completeness 1.1 % of eligible population who are sent an initial offer 90% E and Attendance of offer to screening 100% D 1.2 % of subjects offered screening who are tested. Acceptance of Offer Statistics to be broken down by Scottish Index of Multiple Deprivation (SIMD). Core Uptake 1.3 % of subjects offered screening who are tested 70% E 85% D 1.4 % of subjects who attend for surveillance 90% E (quarterly and yearly data) 100% D Core Completeness of Offer – 1.1 NHS Board Initial Eligible Total Self Total Overall Allocation Participants Allocation Referrals Offered Percentage added since Screening Offered “go live” Collaborative (all 3 4222 4441 8663 218 6021 69.5% Boards) (6021/8663) Grampian 3853 4064 7917 199 5645 71.3% (5645/7917) Orkney 186 178 364 14 205 56.3% (205/364) Shetland 183 199 382 5 171 44.8% (171/382) Due to the large number of eligible participants within the initial allocation all three Boards within the collaborative found that demand exceeded their available capacity. This continues to be a challenge for all Boards but will be monitored closely.