Low rates of aortic surveillance imaging and clinical follow-up in patients with acute aortic dissection

Abstract

Objective: Patients that survive acute aortic dissection (AD) remain at high risk of morbidity/mortality from structural changes of the aorta. Aortic surveillance is challenging, especially within a tertiary referral center. Our aim was to identify follow-up imaging and appointment rates, and factors associated with incomplete surveillance in patients with acute AD.

Methods: This was a single-center, retrospective study of acute AD patients at a tertiary care center from July 2012 to December 2022 who lived at least 1 year after AD. We defined complete surveillance as having computed tomography scans or magnetic resonance imaging scans of the chest and abdomen at 1 month (±14 days), 6 months (±1.5 months), 1 year (±3 months), and yearly thereafter. Data were obtained from the electronic health record. Predictors of absent imaging at the 1 year (±3 months) timepoint were evaluated using multivariable logistic regression.

Results: Of the 272 patients in the study, 63.2% were male and 39.3% were White. The average age was 60.7 ± 14.7 years. Acute type A AD comprised 47.1% of our cohort; 91.4% underwent open repair within 1 week of presentation. Of the acute type B AD patients (52.9% of the cohort), 41.7% underwent thoracic endovascular aortic repair at the index admission. At the 1-year follow-up interval (±3 months), 26.5% were confirmed to have undergone aortic surveillance imaging, and 27.6% had an appointment with a cardiovascular specialist. Only 9.6% of the cohort was fully concordant with the recommended surveillance imaging in the first year of follow-up. On multivariate regression, non-English speakers (odds ratio [OR], 1.19; 95% confidence interval [CI], 1.05-3.99; P = .03) and residence outside of hospital region (OR, 1.66; 95% CI, 1.02-3.17; P = .04) were independently-associated with lack of follow-up imaging at the 1-year timepoint, whereas longer length of stay was independently-associated with completed imaging at the 1-year timepoint (OR, 0.78; 95% CI, 0.41-0.89; P = .04).

Conclusions: This study highlights a low rate of surveillance and clinical follow-up for patients with acute AD and a significant disparity for non-English speaking patients and those who reside outside of the hospital region. This information should inform future quality initiatives to improve aortic surveillance following AD.

Keywords: Acute aortic dissection; Imaging surveillance; Quality improvement.