Evaluating current acute aortic syndrome pathways: collaborative acute aortic syndrome project (CAASP)
Evaluating current acute aortic syndrome pathways: collaborative acute aortic syndrome project (CAASP)
Background: diagnosis of acute aortic syndrome is challenging and associated with high perihospital mortality rates. The study aim was to evaluate current pathways and understand the chronology of acute aortic syndrome patient care.
Method: consecutive patients with acute aortic syndrome imaging diagnosis between 1 January 2018 and 1 June 2021 were identified using a predetermined search strategy and followed up for 6 months through retrospective case note review. The UK National Interventional Radiology Trainee Research and Vascular and Endovascular Research Network co-ordinated the study.
Results: from 15 UK sites, 620 patients were enrolled. The median age was 67 (range 25-98) years, 62.0% were male and 92.9% Caucasian. Type-A dissection (41.8%) was most common, followed by type-B (34.5%); 41.2% had complicated acute aortic syndrome. Mode of presentation included emergency ambulance (80.2%), self-presentation (16.2%), and primary care referral (3.6%). Time (median (i.q.r.)) to hospital presentation was 3.1 (1.8-8.6) h and decreased by sudden onset chest pain but increased with migratory pain or hypertension. Time from hospital presentation to imaging diagnosis was 3.2 (1.3-6.5) h and increased by family history of aortic disease and decreased by concurrent ischaemic limb. Time from diagnosis to treatment was 2 (1.0-4.3) h with interhospital transfer causing delay. Management included conservative (60.2%), open surgery (32.2%), endovascular (4.8%), hybrid (1.4%) and palliative (1.4%). Factors associated with a higher mortality rate at 30 days and 6 months were acute aortic syndrome type, complicated disease, no critical care admission and age more than 70 years (P < 0.05).
Conclusions: this study presents a longitudinal data set linking time-based delays to diagnosis and treatment with clinical outcomes. It can be used to prioritize research strategies to streamline patient care.
Acute Aortic Syndrome, Acute Disease, Adult, Aged, Aged, 80 and over, Aortic Diseases/diagnosis, Aortic Dissection/diagnosis, Female, Humans, Male, Middle Aged, Retrospective Studies, Syndrome, Time-to-Treatment, United Kingdom/epidemiology
Zhong, Jim
a13c3b42-db49-4f44-bff2-d97077528550
Singh, Aminder A.
e47f6d8d-82e0-4f33-9a32-7160fe1b2d65
Safdar, Nawaz Z.
9f30fb6a-fa4a-4f06-b0f2-a27afda6a5fd
Nandhra, Sandip
6eb985e4-55ac-4d8d-9c4d-17c9fbe78415
Vigneswaran, Ganesh
4e3865ad-1a15-4a27-b810-55348e7baceb
1 October 2024
Zhong, Jim
a13c3b42-db49-4f44-bff2-d97077528550
Singh, Aminder A.
e47f6d8d-82e0-4f33-9a32-7160fe1b2d65
Safdar, Nawaz Z.
9f30fb6a-fa4a-4f06-b0f2-a27afda6a5fd
Nandhra, Sandip
6eb985e4-55ac-4d8d-9c4d-17c9fbe78415
Vigneswaran, Ganesh
4e3865ad-1a15-4a27-b810-55348e7baceb
Zhong, Jim, Singh, Aminder A., Safdar, Nawaz Z., Nandhra, Sandip and Vigneswaran, Ganesh
,
CAASP Collaborators
(2024)
Evaluating current acute aortic syndrome pathways: collaborative acute aortic syndrome project (CAASP).
BJS Open, 8 (5), [zrae096].
(doi:10.1093/bjsopen/zrae096).
Abstract
Background: diagnosis of acute aortic syndrome is challenging and associated with high perihospital mortality rates. The study aim was to evaluate current pathways and understand the chronology of acute aortic syndrome patient care.
Method: consecutive patients with acute aortic syndrome imaging diagnosis between 1 January 2018 and 1 June 2021 were identified using a predetermined search strategy and followed up for 6 months through retrospective case note review. The UK National Interventional Radiology Trainee Research and Vascular and Endovascular Research Network co-ordinated the study.
Results: from 15 UK sites, 620 patients were enrolled. The median age was 67 (range 25-98) years, 62.0% were male and 92.9% Caucasian. Type-A dissection (41.8%) was most common, followed by type-B (34.5%); 41.2% had complicated acute aortic syndrome. Mode of presentation included emergency ambulance (80.2%), self-presentation (16.2%), and primary care referral (3.6%). Time (median (i.q.r.)) to hospital presentation was 3.1 (1.8-8.6) h and decreased by sudden onset chest pain but increased with migratory pain or hypertension. Time from hospital presentation to imaging diagnosis was 3.2 (1.3-6.5) h and increased by family history of aortic disease and decreased by concurrent ischaemic limb. Time from diagnosis to treatment was 2 (1.0-4.3) h with interhospital transfer causing delay. Management included conservative (60.2%), open surgery (32.2%), endovascular (4.8%), hybrid (1.4%) and palliative (1.4%). Factors associated with a higher mortality rate at 30 days and 6 months were acute aortic syndrome type, complicated disease, no critical care admission and age more than 70 years (P < 0.05).
Conclusions: this study presents a longitudinal data set linking time-based delays to diagnosis and treatment with clinical outcomes. It can be used to prioritize research strategies to streamline patient care.
Text
zrae096
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More information
Accepted/In Press date: 16 July 2024
e-pub ahead of print date: 19 September 2024
Published date: 1 October 2024
Additional Information:
The authors have no funding to declare. For the purpose of open access, the corresponding author has applied a CC BY public copyright licence to any Author Accepted Manuscript version arising from this submission.
Keywords:
Acute Aortic Syndrome, Acute Disease, Adult, Aged, Aged, 80 and over, Aortic Diseases/diagnosis, Aortic Dissection/diagnosis, Female, Humans, Male, Middle Aged, Retrospective Studies, Syndrome, Time-to-Treatment, United Kingdom/epidemiology
Identifiers
Local EPrints ID: 495185
URI: http://eprints.soton.ac.uk/id/eprint/495185
ISSN: 2474-9842
PURE UUID: 8832a902-e517-42ce-96a1-604f7fb4151e
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Date deposited: 31 Oct 2024 17:35
Last modified: 01 Nov 2024 03:00
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Contributors
Author:
Jim Zhong
Author:
Aminder A. Singh
Author:
Nawaz Z. Safdar
Author:
Sandip Nandhra
Corporate Author: CAASP Collaborators
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