Evolving dynamic needs for patient-reported outcomes assessment in individuals with an abdominal aortic aneurysm (AAA): A systematic review

Abdominal aortic aneurysm (AAA) affects over 35 million individuals and poses a potentially fatal risk. Risk stratification and surveillance strategies are well established, but their impact on patient-reported outcomes (PROs) remains diffuse and may vary by clinical and biopsychosocial profiles. It is also unclear whether individuals with this often 'silent' condition experience thriving or growth concepts referred to as 'flourishing.' To address these gaps, we systematically reviewed PRO studies in AAA to answer three questions: (1) Are there instruments tailored to AAA phenotypes (rupture, elective repair, surveillance, screening), and what patient-centered dimensions are measured? (2) What mental health assessments are commonly used? (3) Do existing PROs capture elements of flourishing? We included 16 studies. Generic PRO tools were frequently used but limited in scope. Five AAA-specific instruments were identified, focusing on physical symptoms, treatment satisfaction, and disease burden. Most were developed using Classical Test Theory, with item burden ranging from 11 to 70 items, and primarily targeted surveillance or elective surgery populations. Mental health assessment was minimal - typically single items embedded in health status instruments addressing anxiety and depression. Flourishing was indirectly assessed through measures of social connection and emotional well-being. Current PRO approaches fail to capture the heterogeneous, patient-centered experience of living with AAA. We propose a growth-based framework for PRO evaluation using adaptive testing to accommodate clinical complexity while minimizing response burden, supporting integrative, value-based, patient-centered care.