Patient reassurance and education needed to address drop in AAA surveillance engagement during pandemic

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In a survey conducted by St George’s Vascular Institute (London, UK) on the willingness of patients in South London to attend abdominal aortic aneurysm (AAA) surveillance during the COVID-19 pandemic, just under 60% of patients said they would attend a scan in July, compared to a pre-COVID attendance rate of around 90%.

The research team cite fear of catching the virus and public transport concerns as key factors in patients’ reluctance. At this year’s UK Vascular Societies’ Annual Scientific Meeting (VS ASM 2020; 24–27 November, virtual), Will Selway, a trainee at the centre, outlined key findings from the study and considered ways to encourage attendance going forward.

Selway noted that the UK National Abdominal Aortic Aneurysm Screening Programme (NAAASP) was suspended in March in line with the national lockdown. At the time the survey was conducted in May, there were 667 men with small- to medium-sized aneurysms (3–5.4cm) under surveillance in South London, he reported, detailing that 271 of these men had had their scans postponed due to the lockdown, and that the remaining 354 had either been seen prior to the virus outbreak or were due scans later in the year after the initial lockdown was planned to end.

The St George’s team contacted 200 of the men from the postponed surveillance group and asked them five questions about attending surveillance scanning. Selway mentioned that the team had access to basic comorbidity information, which allowed them to produce a stratified risk score for COVID-19 infection.

Infection fears reduce likelihood of surveillance attendance

In answer to the question, “If you were invited for your surveillance appointment in July, how likely are you to attend?” 59% of the men confirmed that they would attend. Selway remarked that this represents “quite a drop” from the pre-COVID 89.8% level of attendance in South London. He reported that the team did not find any significant difference when they took into consideration aneurysm size.

The second question the team asked regarded patients’ main health concerns. When they reviewed the results using a stratified risk score, they found that 25.5% of patients across the risk categories were most concerned about their aneurysm, while 42.5% felt that catching COVID was their main concern. When they looked at this again by aneurysm size, 45% in the small aneurysm cohort were most concerned about catching COVID-19, whereas in the medium-sized aneurysm cohort, there was equal concern of 38.2% between catching COVID-19 and their aneurysm.

In addition, Selway reported that only 20.6% of these patients received a letter from their GP advising them to shield, which would imply that they are in a high-risk group. However, the team’s risk scoring suggested that 74% of the men were in the high-risk group and therefore probably should have received advice to shield from their GP.

Regarding specific concerns about actually attending their screening appointment, the St George’s team found that 31.7% of the men were most concerned about having to use public transport, while 22.6% were concerned with having to wait in open waiting areas.

Finally, in terms of how far patients would be willing to travel if their local surveillance centre was not open, over half the men (56%) felt that they would only be willing to travel between one and three miles for their scan.

Concluding, Selway reiterated that there was 90% attendance before COVID for surveillance in South London, and at the time their report was produced in May, about 60% of patients said they would attend screening. The presenter considered possible implications: “If this is mirrored in the uptake of initial screening invitations, we are likely to see a drop there, and the worry is that if there is reduced engagement in both screening and surveillance scans, we may end up seeing an increase in the presentation of ruptured aneurysms and aneurysm-related mortality”.

“I think, going forward, it is important to reassess patients’ perceptions of risk as we learn more about managing and preventing COVID-19 infection,” he concluded.

Education and trust essential as knowledge of COVID-19 increases

In the discussion following Selway’s presentation, chair Richard Gibbs (Imperial College Healthcare NHS Trust, London, UK) remarked that the results are “quite depressing,” and asked what could be done to convince patients that “they are more at risk of their aneurysm rupturing than they are of dying of COVID”.

Selway responded: “I think it is partly about gaining their trust that it is safe to come for the scan,” he summarised that patient education was an important aspect of care, adding that aneurysms should be prioritised in someone’s health concerns.

On the same topic, an audience member asked if Selway believes the risks that are posed to patients about COVID-19 have been exaggerated, and whether this has impacted attendance level. Selway remarked that early on the virus was an “unknown phenomenon” and that looking back there may well have been an exaggeration in terms of risk, and this likely did affect attendance. Now that there is a better understanding and vaccinations are on the way, he stressed that reassessing patient perceptions was key to increasing their engagement.

While Selway detailed use of public transport and the reluctance to travel as other areas that could impact on surveillance attendance, one audience member was interested to know if the team had any data on whether there are differences in attendance depending on where the scans are taking place.

He replied that while the team did not have hard data on where patients were having their scans, the presenter speculated that so far as transport were concerned, in the more rural areas of the catchment, patients would be more likely to have a private vehicle, whereas in the city there is more likely to be a reliance on public transport. He also thought that if a patient is told to go to a large university teaching hospital that is looking after a lot of COVID-19 patients then this would likely deter them from going to the hospital. Conversely, if the patient is asked to go to much smaller facility with a scanner then “that is more likely to be appealing”. He echoed that currently, however, the team does not have these data points available.


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