Innovative program identifies at-risk abdominal aortic aneurysm patients who may have been ‘lost-to-follow-up’ care
Like many people, the last thing Tim Stottlemyer wanted to do was go to the doctor after being involved in a head-on collision.
“I was just so frustrated about wrecking my car and busy working on replacing it, I didn't feel like I had time to go to the doctor,” Stottlemyer recalled.
Within months of the accident, Stottlemyer soon began experiencing severe stomach cramps. After being urged by his family, he went to see his doctor and an ultrasound soon identified a small abdominal aortic aneurysm. This is a weak, bulging area in the section of the aorta that runs through the abdomen.
“Luckily, my doctor explained it was a small aneurysm and I didn’t need surgery – but it did need to be monitored,” Stottlemyer said. “I felt relieved just knowing why I was having stomach pain.”
Abdominal aortic aneurysms that have been discovered prior to rupture need to be measured, closely monitored and evaluated for treatment. Small aneurysms, those less than five centimeters in diameter, can often be left untreated, but they need to be checked periodically or growth.
Following his appointment, Stottlemyer returned to his busy, everyday life. He still experienced occasional stomach cramps – but felt comforted at least knowing the cause of them.
“Unfortunately, I did not stay on top of monitoring my aneurysm,” said Stottlemyer. “Life gets busy, and you keep thinking that you will make an appointment soon to get checked – but it just falls through the cracks.”
Then, Stottlemyer received a call from a UC Davis Health nurse navigator who explained she was calling because a new abdominal aortic aneurysm surveillance program identified him as a patient needing follow-up surveillance for his aneurysm.
“When I got the call, I figured it was a sign that I should get a check-up,” Stottlemyer remembered.
During his follow-up appointment, it was discovered that Stottlemyer’s aneurysm had grown, and he required surgery to treat it before it ruptured.
Open aneurysm repair
Stottlemyer was quickly scheduled for surgery at UC Davis Medical Center. He underwent an Abdominal Aortic Aneurysm Open Repair, where a large incision is made in the abdomen to repair the aneurysm. A cylinder-like tube called a graft is often used during the procedure. Grafts are made of various materials such as:
- Dacron (textile polyester synthetic graft)
- Polytetrafluoroethylene (PTFE, non-textile synthetic graft)
This graft is sewn to the aorta, connecting the healthy aorta at each end of the aneurysm to replace the diseased segment. The open repair is considered the surgical standard for an abdominal aortic aneurysm.
“We were fortunate to identify Tim's need for surgery prior to his aneurysm rupturing,” explained Mimmie Kwong, assistant professor of vascular surgery, who performed his procedure. “About 50% of patients who experience an aneurysm rupture never even make it to the hospital.”
Three days after his surgery, Stottlemyer began walking around the hospital and soon was discharged home.
“Efforts like our new surveillance program are saving lives,” added Kwong. “Being able to catch patients like Tim, who had aneurysms that were detected and who were not receiving follow-up care for whatever reason, allows us to treat their aneurysms when they are smaller and before they have ruptured. This makes their procedures much less complex and minimizes their risk of death."
Innovative surveillance program
In collaboration with AI (artificial intelligence) software company Illuminate, UC Davis Health began its centralized abdominal aortic aneurysm surveillance program in June 2022. The program identifies at-risk abdominal aortic aneurysm (AAA) patients who may have been ‘lost-to-follow-up’ because they missed care during the pandemic or other factors.
“One of our goals is to alleviate the burden of aortic surveillance from primary care physicians,” explained Meredith Hickerson, lead clinical nurse navigator for the surveillance program. “We provide reminders to providers when patients are due for imaging. This process serves as a safety net for patients and providers to ensure timely lifelong aortic surveillance.”
In its first eight months, the program has identified over 11,600 patients with some mention of AAA who could benefit from monitoring. Over 10,600 patients were reviewed and 950 patients who were lost to care are now under active surveillance and management by nurse navigators.
Of those, 96 patients visited UC Davis Health, which resulted in 151 diagnostic imaging studies, one diagnostic angiogram, and 13 life-saving AAA surgical procedures.
“Leveraging the Illuminate software, our nurse navigators have been able to efficiently review patients with aortic aneurysms and identify patients overdue for follow up,” added Hickerson. “This program greatly illustrates the high quality of care delivered at UC Davis Health, as we have invested in technology and services that provide follow up and thus been able to save lives.”
Thankful and recovered
Stottlemyer celebrated the new year by returning to work just three months after his surgery.
“I am just so thankful for the care I received and to be where I am now,” Stottlemyer said. “When you get the call, you don't know what to expect – lots of worry goes through your head when you hear aneurysm. Knowing I was being monitored for follow-up care provided me so much comfort and has helped me build trust with my providers.”