@article { , title = {Endovascular strategy or open repair for ruptured abdominal aortic aneurysm: One-year outcomes from the IMPROVE randomized trial}, abstract = {© 2015 The Author. Aims To report the longer term outcomes following either a strategy of endovascular repair first or open repair of ruptured abdominal aortic aneurysm, which are necessary for both patient and clinical decision-making. Methods and results This pragmatic multicentre (29 UK and 1 Canada) trial randomized 613 patients with a clinical diagnosis of ruptured aneurysm; 316 to an endovascular first strategy (if aortic morphology is suitable, open repair if not) and 297 to open repair. The principal 1-year outcome was mortality; secondary outcomes were re-interventions, hospital discharge, health-related quality-of-life (QoL) (EQ-5D), costs, Quality-Adjusted-Life-Years (QALYs), and cost-effectiveness [incremental net benefit (INB)]. At 1 year, all-cause mortality was 41.1\% for the endovascular strategy group and 45.1\% for the open repair group, odds ratio 0.85 [95\% confidence interval (CI) 0.62, 1.17] , P = 0.325, with similar re-intervention rates in each group. The endovascular strategy group and open repair groups had average total hospital stays of 17 and 26 days, respectively, P < 0.001. Patients surviving rupture had higher average EQ-5D utility scores in the endovascular strategy vs. open repair groups, mean differences 0.087 (95\% CI 0.017, 0.158), 0.068 (95\% CI-0.004, 0.140) at 3 and 12 months, respectively. There were indications that QALYs were higher and costs lower for the endovascular first strategy, combining to give an INB of £3877 (95\% CI £253, £7408) or 4356 (95\% CI 284, 8323). Conclusion An endovascular first strategy for management of ruptured aneurysms does not offer a survival benefit over 1 year but offers patients faster discharge with better QoL and is cost-effective.}, doi = {10.1093/eurheartj/ehv125}, eissn = {1522-9645}, issn = {0195-668X}, issue = {31}, journal = {European Heart Journal}, pages = {2061-2069}, publicationstatus = {Published}, publisher = {Oxford University Press}, url = {https://hull-repository.worktribe.com/output/522759}, volume = {36}, keyword = {Health and Health Inequalities, Aneurysm, Aorta, Rupture, Surgery, Stent grafts, Cost-effectiveness}, year = {2015}, author = {Braithwaite, Bruce and Greenhalgh, Roger M. and Grieve, Richard and Hassan, Tajek B. and Moore, Fionna and Nicholson, Anthony A. and Soong, Chee V. and Heatley, Francine and Anjum, Aisha and Kalinowska, Gosia and Gomes, Manuel and Powell, Janet T. and Hinchliffe, Robert and Sweeting, Michael and Thompson, Matt M. and Thompson, Simon G. and Ulug, Pinar and Roberts, Ian and Bell, Peter R.F. and Cheetham, Anne and Stephany, Jenny and Halliday, Alison W. and Warlow, Charles and Lamont, Peter and Moss, Jonathan and Tijssen, Jan and Ashleigh, Ray and Thompson, Matthew and Thompson, Luke and Cheshire, Nicholas J. and Boyle, Jonathan R. and Serracino-Inglott, Ferdinand and Hinchliffe, Robert J. and Bell, Rachel and Wilson, Noel and Bown, Matt and Dennis, Martin and Davis, Meryl and Howell, Simon and Wyatt, Michael G. and Valenti, Domenico and Bachoo, Paul and Walker, Paul and MacSweeney, Shane and Davies, Jonathan N. and Rittoo, Dynesh and Parvin, Simon D. and Yusuf, Waquar and Nice, Colin and Chetter, Ian and Howard, Adam and Chong, Patrick and Bhat, Raj and McLain, David and Gordon, Andrew and Lane, Ian and Hobbs, Simon and Pillay, Woolagasen and Rowlands, Timothy and El-Tahir, Amin and Asquith, John and Cavanagh, Steve and Dubois, Luc and Forbes, Thomas L. and Ashworth, Emily and Baker, Sara and Barakat, Hashem and Brady, Claire and Brown, Joanne and Bufton, Christine and Chance, Tina and Chrisopoulou, Angela and Cockell, Marie and Croucher, Andrea and Dabee, Leela and Dewhirst, Nikki and Evans, Jo and Gibson, Andy and Gorst, Siobhan and Gough, Moira and Graves, Lynne and Griffin, Michelle and Hatfield, Josie and Hogg, Florence and Howard, Susannah and Hughes, Cián and Metcalfe, David and Lapworth, Michelle and Massey, Ian and Novick, Teresa and Owen, Gareth and Parr, Noala and Pintar, David and Spencer, Sarah and Thomson, Claire and Thunder, Orla and Wallace, Tom and Ward, Sue and Wealleans, Vera and Wilson, Lesley} }