PROGNOSIS IN ELDERLY MEN WITH SCREENING-DETECTED ABDOMINAL AORTIC-ANEURYSM

Objectives: To study the natural course of screening-detected symptoml ess abdominal aortic aneurysm (AAA) in elderly men. Setting: Malmo, a city in southern Sweden with 230 000 inhabitants and a single referral hospital. Materials: 423 seventy-four-year-old men, randomly selected from the population and belonging to the prospective population study ''Men bent in 1914'', were invited. 343 underwent AAA screening, wher eas 80 declined or had moved. Chief outcome measures: Five year all ca use mortality in relation to participation in and findings at ultrasou nd screening for AAA. Main results: An abdominal aortic aneurysm was p resent in 38 (11%) out 340 men who underwent screening and who had a n ative aorta. During 5 years of follow-up, one third (13/38) of these m en died; 7 from myocardial infarction and 3 from stroke. The mortality rate in men with AAA was 80.2/1000 person years; twice as high as it tons in men without AAA (39.4/1000 person years; p = 0.018). Six men u nderwent AAA surgery. None of them died from aneurysm rupture. However aneurysm surgery did not reduce the total mortality rare in these men . The highest mortality rate, 91.9/1000 person years, was found in the men who did not participate in the screening. Conclusions: It is our conclusion that screening for early defection and intervention is of q uestionable value from a public health perspective.