Article Impact Level: HIGH Data Quality: STRONG Summary of Circulation: Population Health and Outcomes https://doi.org/10.1161/CIRCOUTCOMES.125.012472 Dr. Frank M. Davis et al.
Points
- A statewide partnership in Michigan successfully increased the rate of follow up imaging after endovascular aortic aneurysm repair from twenty eight percent to nearly eighty percent within six years.
- Patients who participated in annual surveillance imaging experienced a nearly sixty percent decrease in the likelihood of one year mortality after surgeons controlled for various clinical comorbidities and health factors.
- The initiative utilized a financial insurance reimbursement model to encourage over thirty participating hospitals to integrate essential long term radiologic monitoring into their routine postoperative cardiovascular care and practice.
- Participating hospitals demonstrated widespread improvement regardless of their size as ninety five percent of facilities achieved surveillance rates above sixty percent by the conclusion of the six year study.
- While patients receiving regular imaging required a higher number of repeat interventions to fix device failures they ultimately achieved significantly lower mortality rates compared to those without regular medical follow up.
Summary
This study evaluated the impact of a statewide quality improvement initiative, implemented through the Blue Cross Blue Shield of Michigan Cardiovascular Consortium (BMC2), on postoperative imaging compliance and one-year mortality following endovascular aneurysm repair (EVAR). While Society for Vascular Surgeons guidelines recommend annual lifelong surveillance, baseline data indicated that 57% of patients were missing essential follow-up. Prior to the intervention, surveillance rates varied significantly across Michigan, ranging from 3.7% at smaller facilities to 62.5% at larger centers.
The implementation of a program linking financial insurance reimbursement to surveillance adherence across more than 30 hospitals resulted in a significant increase in statewide imaging rates. Follow-up compliance rose from 28% in 2017 to just below 80% by 2023, with 95% of participating institutions achieving surveillance rates exceeding 60%. Although patients undergoing regular surveillance required a higher volume of repeat interventions—addressing the 14% of patients who typically require secondary procedures within five years—the early detection of device failure and complications was clinically significant.
Statistical analysis demonstrated that patients who participated in surveillance imaging had a nearly 60% decrease in the likelihood of one-year mortality after controlling for comorbidities. This reduction in mortality occurred despite the known risk of late aortic rupture, which affects less than 2% of the 200,000 Americans diagnosed with abdominal aortic aneurysms annually. These results suggest that standardizing postoperative protocols through regional consortiums and financial incentives is a viable strategy to enhance long-term survival and prevent catastrophic device failure.
Link to the article: https://www.ahajournals.org/doi/10.1161/CIRCOUTCOMES.125.012472
References
Davis, F. M., Albright, J., Callow, B., Kobbani, L., Thai, H., Boules, T., Mouawad, N. J., & Harold Osborne, N. (2026). Association between creation of an endovascular aortic aneurysm surveillance program and 1-year follow-up and mortality in the state of michigan, united states. Circulation: Population Health and Outcomes, e012472. https://doi.org/10.1161/CIRCOUTCOMES.125.012472
