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Veterinarians have been thinking about preventive care protocols in their clinics for some time now offering annual wellness checks. These annual checks may include vaccination based on the patient’s individual needs, and may or may not include diagnostics. For some, the decision not to include diagnostics in the wellness check has been due to consideration of whether there is value in adding diagnostic testing when a patient has an unremarkable history and clinical examination, but the evidence to do so is mounting.
Several peak bodies have produced guidelines on care of dogs and cats at different life stages, including the American Association of Feline Practitioners (AAFP)1,2, the American Animal Hospital Association (AAHA)3,4, and the Australian Veterinary Association5. All of these recommend regular health checks (annual for adults, and every 6 months for seniors and older), with diagnostic testing included, especially as animals age.
Add to this, a series of published studies evaluating the results of diagnostic testing in apparently healthy adult and senior pets, and we can start to draw some evidence-based conclusions around the value of diagnostics in this preventive care setting. In a study of 100 cats6 and one involving 100 dogs7, there were significant numbers of patients with changes on blood and urine screens, and a more recent study undertaken in Australia involving 406 dogs and 130 cats showed 6.2% of dogs and 19.2% of cats with significant changes that warranted further investigation8.
AAHA however, were interested in leveraging the huge volumes of data produced by the industry each year to understand the issue on a much larger scale, and took a somewhat different approach to data collection9. In their ‘Big Data’ study, the AAHA research team evaluated over 268,000 patients, but not necessarily in the same detail as the previous studies.
Here are some details from the study that all veterinarians should be aware of:
- Data was gathered from 5,016 consenting practices and harvested from their practice management software.
- Investigators evaluated profiles on patients that were classified as ‘wellness examinations’ in the practice information management system.
- The patient visit needed to include a CBC, full chemistry profile including IDEXX SDMA®, and ideally a urinalysis.
- For some parameters, the reference interval was widened slightly to a critical threshold before a result was abnormal (for example for liver enzymes the lower range was set to zero, and in dogs the upper end of phosphorus was increased by 25%).
- For the majority of biochemical parameters, the requirement was that at least three or more results had to be abnormal before the findings were considered significant.
- A single abnormal SDMA result was considered significant.
- For haematology, only numerical values were assessed (changes on blood film reviews were not included), and abnormalities identified included: Anaemia, Reticulocytosis, Leucocytosis, Stress leucogram (lymphopaenia and eosinopaenia) & Eosinophilia
In many regards the approach taken was a conservative one and means that potentially significant changes were under-reported. This in-built ‘conservativism’ is because not all the haematological parameters were evaluated, and there was no comparison to previous results.
Where we now recognise the benefits of evaluating the health status of the pet by using an individual reference interval (comparing current results to previous results obtained for that patient in health) for a number of routine parameters, creatinine being a good example.
In the AAHA study the results were as follows, with respect to results that warranted further investigation.
In this study the addition of SDMA made a significant difference to the number of patients warranting further evaluation. In the adult and senior populations there were an extra 6 per 100 patients who required further investigation, whereas it was 13 per 100 for geriatric patients.
In conclusion, and as we seek to enhance the health and wellbeing of pets, people and livestock, I would suggest that studies such as the ones discussed here provide supporting evidence that the inclusion of diagnostic testing in discussions on wellness and preventive care is critical. Moreover, observation suggests that it is also something that clients have come to expect. The Animal Medicines Australia Pet Ownership 2016 report showed nearly as many clients presented their pets to the vet to keep them well as those presenting for illness10. V
Dr Graham Swinney BVSc, FANZCVS (canine medicine)
1. Hoyumpa Vogt A et al. AAFP-AAHA Feline Life Stage Guidelines. J Am Anim Hosp Assoc (2010); 46: 70-85.
2. Pittari J et al. American Association of Feline Practitioners Senior Care Guidelines. Journal of Feline Medicine and Surgery (2009); 11: 763-778.
3. Bartges J et al. AAHA Canine Life Stage Guidelines. J Am Anim Hosp Assoc (2012); 48: 1-11
4. Epstein M et al. AAHA Senior Care Guidelines for Dogs and Cats. J Am Anim Hosp Assoc 2005; 41: 81-91.
5. Standards of Care: Regular Health Check Standards for Dogs and Cats (2013). Accessed on line March 28, 2019.
6. Paepe D et al. Routine Health Screening. Findings in apparently healthy middle-aged and old cats. Journal of Feline Medicine and Surgery (2013); 15: 8-19.
7. Willems A et al. Results of Screening of Apparently Healthy Senior and Geriatric Dogs. J Vet Intern Med (2017); 31: 81-92.
8. Dell’Osa D et al. Prevalence of clinicopathological changes in healthy middle-aged dogs and cats presenting to veterinary practices for routine procedures. Aust Vet J (2016); 94: 317-323.
9. Promoting Preventive Care Protocols. American Animal Hospital Association. https://www.aaha.org/public_documents/professional/resources/promoting_preventive_care_protocols.pdf Accessed on line March 28, 2019.
10. Pet Ownership in Australia 2016. Animal Medicines Australia. https://animalmedicinesaustralia.org.au/wp-content/uploads/2016/11/AMA_Pet-Ownership-in-Australia-2016-Report_sml.pdf Accessed on line March 28, 2019