Practice Update - ESC Congress 2017

more cost-effective than many existing programs such as screening for breast or colon cancer and holds the potential to be a game changer in public health prevention.” Dr. Lindholt noted, “This might be a poten- tial game-changer.” Drs. Lindholt and Søgaard said the results should prompt policymakers to consider implementing such programs. Importantly, said Dr. Lindholt, no serious negative side effects of the screening program, including postoperative deaths, CNS bleeding, diabetes mellitus, cancer, uremia, quality of life, overdiagnosis, or overtreatment were reported. In an editorial accompanying the results published in The Lancet, Chadi Ayoub, MBBS, and M. Hassan Murad, MD, both of the Mayo Clinic, Rochester, Minnesota, pointed out that the number needed to screen compares “favorably” with com- mon cancer screening initiatives, which in which many more subjects need to be screened to prevent one death. Drs. Ayoub and Murad questioned the bundling of two screening tests known to translate into reduced events (abdom- inal aortic aneurysm and hypertension screening) with ankle-brachial index screening, “which to date has not shown to be effective.” Ankle-brachial index is

of women in the study was the “first thing” she noticed, though she acknowledged that abdominal aortic aneurysm is far less common in women. “Screening programs such as the one described are relatively cheap to do," she said, “though they would require some degree of staffing and coordina- tion. Whether such a strategy would be cost-effective in the UK would need to be determined,” she said. In VIVA, the average screening cost was €2148 per quality-of-life year gained. “We’d have to look at that from a public health perspective and assess the cost in the con- text of everything else the National Health Service is evaluating,” she said. Jacob Thorsted Sørensen, MD, PhD, of Aarhus University Hospital, Denmark, said that he would want to know more about how the screening was performed and how it could be applied population-wide. “But I think what really is interesting here,” he said, “is that you have a potentially high-risk population, which you are able to identify with relatively simple means, and there were no adverse effects of the screening, compared to cancer, for example, with a lot of extra investigations and needle biopsies and so on.”

not recommended by the US Preventive Services Task Force, though other groups support the test to varying degrees. Drs. Ayoub and Murad said, “The fact that ankle-brachial index is being conferred legitimacy by such bundling is concerning.” Overall, they concluded, the VIVA trial presented thought-provoking findings, though “implementation of this triple screening intervention requires more proof than presented in this study.” Dr. Lindholt said that men are significantly more likely to develop abdominal aortic aneurysm than women, the reason men only were included. Dr. Lindholt said, “We did the study in areas where we thought there would be the benefit of most cost-effective testing and we had some pilot studies searching for abdominal aortic aneurysm in women. These confirmed the prevalence is still very, very low in women.” Pilot studies in the run-up to VIVA demonstrated that the prevalence of peripheral artery disease was comparable in men and women. Drs. Lindholt and Søgaard plan no simi- lar screening study in women. They are moving forward with a “multifaceted” screening test applicable to both genders. Sarah Clarke, MD, of the Cambridge Heart Clinic, UK, explained that the lack

PracticeUpdate Editorial Team

ESC Congress 2017 • PRACTICEUPDATE CONFERENCE SERIES 21