Fast track pathway reduces sight loss in giant cell arteritis: results of a longitudinal observational cohort study

Clin Exp Rheumatol. Mar-Apr 2015;33(2 Suppl 89):S-103-6. Epub 2015 May 26.

Abstract

Objectives: To investigate the effectiveness of a fast track pathway (FTP) on sight loss in patients with suspected giant cell arteritis (GCA).

Methods: A longitudinal observational cohort study was conducted in the secondary care rheumatology department. One hundred and thirty-five newly referred suspected GCA patients seen via the FTP (Jan. 2012-Dec. 2013) were compared to 81 patients seen through the conventional referral and review system (Jan. 2009-Dec. 2011).

Results: The FTP resulted in significant reduction in irreversible sight loss from 37.0% (as seen in the historical cohort 2009-2011) to 9.0 % (2012-2013, OR 0.17, p=0.001). Adjustment for clinical and demographic parameters including known risk factors for GCA associated blindness did not significantly change the primary result (OR 0.08, p=0.001). FTP resulted in a reduction of time from symptom onset to diagnosis, particularly by reduction of time from general practitioner's (GP) referral to the rheumatology review (79% of FTP patients were seen within one working day compared to 64.6 % in the conventional pathway, p=0.023). The FTP has seen a reduction in number of GP appointments.

Conclusions: There was a significant reduction of permanent sight loss with a fast track GCA pathway. The effect may be due to multiple factors including better GP education and reduction in delayed diagnosis. These results need verification at other sites.

Publication types

  • Observational Study

MeSH terms

  • Aged
  • Aged, 80 and over
  • Blindness / etiology*
  • Cohort Studies
  • Critical Pathways*
  • Delayed Diagnosis
  • Early Medical Intervention
  • Female
  • Giant Cell Arteritis / complications
  • Giant Cell Arteritis / diagnosis
  • Giant Cell Arteritis / drug therapy*
  • Glucocorticoids / therapeutic use*
  • Humans
  • Longitudinal Studies
  • Male
  • Referral and Consultation*
  • Retrospective Studies
  • Temporal Arteries / pathology*
  • Time-to-Treatment*

Substances

  • Glucocorticoids