Socioeconomic disparities in surveillance and follow-up of patients with thoracic aortic aneurysm.

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Clinical Guidelines
Authored By
Shang M, Weininger G, Mori M, Kahler-Quesada A, Degife E, Brooks C, Yousef S, Williams M, Assi R, Geirsson A, Vallabhajosyula P
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Cardiology
Pulmonology
Emergency Medicine
Speciality
Cardiology
Emergency Medicine
Pulmonology
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volume
37
ISSN
1540-8191
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{"article_title":"Socioeconomic disparities in surveillance and follow-up of patients with thoracic aortic aneurysm.","author":"Shang M, Weininger G, Mori M, Kahler-Quesada A, Degife E, Brooks C, Yousef S, Williams M, Assi R, Geirsson A, Vallabhajosyula P","journal_title":"Journal of cardiac surgery","issn":"1540-8191","isbn":"","publication_date":"2022 Apr","volume":"37","issue":"4","first_page":"831","page_count":"","accession_number":"34873754","doi":"10.1111\/jocs.16173","publisher":"Wiley-Blackwell","doctype":"Journal Article","subjects":"Aortic Aneurysm, Thoracic diagnosis; Aortic Aneurysm, Thoracic epidemiology; Aortic Aneurysm, Thoracic surgery; Follow-Up Studies; Humans; Retrospective Studies; Risk Factors; Socioeconomic Factors; Tomography, X-Ray Computed","interest_area":["Cardiology"," Pulmonology"," Emergency Medicine"],"abstract":"Background: Thoracic aortic aneurysm (TAA) is a significant risk factor for aortic dissection and rupture. Guidelines recommend referral of patients to a cardiovascular specialist for periodic surveillance imaging with surgical intervention determined primarily by aneurysm size. We investigated the association between socioeconomic status (SES) and surveillance practices in patients with ascending aortic aneurysms. Methods: We retrospectively reviewed records of 465 consecutive patients diagnosed between 2013 and 2016 with ascending aortic aneurysm ?4 cm on computed tomography scans. Primary outcomes were clinical follow-up with a cardiovascular specialist and aortic surveillance imaging within 2 years following index scan. We stratified patients into quartiles using the area deprivation index (ADI), a validated percentile measure of 17 variables characterizing SES at the census block group level. Competing risks analysis was used to determine interquartile differences in risk of death before follow up with a cardiovascular specialist. Results: Lower SES was associated with significantly lower rates of surveillance imaging and referral to a cardiovascular specialist. On competing risks regression, the ADI quartile with lowest SES had lower hazard of follow-up with a cardiologist or cardiac surgeon before death (hazard ratio: 0.46 [0.34, 0.62], p < .001). Though there were no differences in aneurysm size at time of surgical repair, patients in the lowest socioeconomic quartile were more frequently symptomatic at surgery than other quartiles (92% vs. 23%-38%, p < .001). Conclusion: Patients with lower SES receive less timely follow-up imaging and specialist referral for TAAs, resulting in surgical intervention only when alarming symptoms are already present. \ufffd 2021 Wiley Periodicals LLC.","url":"https:\/\/search.ebscohost.com\/login.aspx?direct=true&db=mdl&AN=34873754&authtype=shib&custid=ns346513","isPdfLink":true,"isSAML":false,"additionalInfo":{"Authored_By":"Shang M, Weininger G, Mori M, Kahler-Quesada A, Degife E, Brooks C, Yousef S, Williams M, Assi R, Geirsson A, Vallabhajosyula P","Journal_Info":"Publisher: Wiley-Blackwell Country of Publication: United States NLM ID: 8908809 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1540-8191 (Electronic) Linking ISSN: 08860440 NLM ISO Abbreviation: J Card Surg Subsets: MEDLINE","Publication_Type":"Journal Article","Published_Date":"2022-04-01","Source":"Journal of cardiac surgery [J Card Surg] 2022 Apr; Vol. 37 (4), pp. 831-839. Date of Electronic Publication: 2021 Dec 06.","Languages":"English","Electronic_ISSN":"1540-8191","MeSH_Terms":"Aortic Aneurysm, Thoracic*\/diagnosis , Aortic Aneurysm, Thoracic*\/epidemiology , Aortic Aneurysm, Thoracic*\/surgery, Follow-Up Studies ; Humans ; Retrospective Studies ; Risk Factors ; Socioeconomic Factors ; Tomography, X-Ray Computed","Subjects":"Follow-Up Studies, Humans, Retrospective Studies, Risk Factors, Socioeconomic Factors, Tomography, X-Ray Computed, Aortic Aneurysm, Thoracic diagnosis, Aortic Aneurysm, Thoracic epidemiology, Aortic Aneurysm, Thoracic surgery","Title_Abbreviations":"Journal of cardiac surgery","Volume":"37"},"header":{"DbId":"mdl","DbLabel":"MEDLINE Ultimate","An":"34873754","RelevancyScore":"883","PubType":"Academic Journal","PubTypeId":"academicJournal","PreciseRelevancyScore":"882.704467773438"},"plink":"https:\/\/search.ebscohost.com\/login.aspx?direct=true&site=eds-live&db=mdl&AN=34873754&authtype=shib&custid=ns346513&group=main&profile=eds","upload_link":"https:\/\/search.ebscohost.com\/login.aspx?direct=true&site=eds-live&db=mdl&AN=34873754&authtype=shib&custid=ns346513&group=main&profile=eds"}
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1540-8191
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Additional Info
["Shang M, Weininger G, Mori M, Kahler-Quesada A, Degife E, Brooks C, Yousef S, Williams M, Assi R, Geirsson A, Vallabhajosyula P","Publisher: Wiley-Blackwell Country of Publication: United States NLM ID: 8908809 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1540-8191 (Electronic) Linking ISSN: 08860440 NLM ISO Abbreviation: J Card Surg Subsets: MEDLINE","Journal Article","2022-04-01","Journal of cardiac surgery [J Card Surg] 2022 Apr; Vol. 37 (4), pp. 831-839. Date of Electronic Publication: 2021 Dec 06.","English","1540-8191","Aortic Aneurysm, Thoracic*\/diagnosis , Aortic Aneurysm, Thoracic*\/epidemiology , Aortic Aneurysm, Thoracic*\/surgery, Follow-Up Studies ; Humans ; Retrospective Studies ; Risk Factors ; Socioeconomic Factors ; Tomography, X-Ray Computed","Follow-Up Studies, Humans, Retrospective Studies, Risk Factors, Socioeconomic Factors, Tomography, X-Ray Computed, Aortic Aneurysm, Thoracic diagnosis, Aortic Aneurysm, Thoracic epidemiology, Aortic Aneurysm, Thoracic surgery","Journal of cardiac surgery","37"]
Description
Background: Thoracic aortic aneurysm (TAA) is a significant risk factor for aortic dissection and rupture. Guidelines recommend referral of patients to a cardiovascular specialist for periodic surveillance imaging with surgical intervention determined primarily by aneurysm size. We investigated the association between socioeconomic status (SES) and surveillance practices in patients with ascending aortic aneurysms.<br />Methods: We retrospectively reviewed records of 465 consecutive patients diagnosed between 2013 and 2016 with ascending aortic aneurysm ≥4 cm on computed tomography scans. Primary outcomes were clinical follow-up with a cardiovascular specialist and aortic surveillance imaging within 2 years following index scan. We stratified patients into quartiles using the area deprivation index (ADI), a validated percentile measure of 17 variables characterizing SES at the census block group level. Competing risks analysis was used to determine interquartile differences in risk of death before follow up with a cardiovascular specialist.<br />Results: Lower SES was associated with significantly lower rates of surveillance imaging and referral to a cardiovascular specialist. On competing risks regression, the ADI quartile with lowest SES had lower hazard of follow-up with a cardiologist or cardiac surgeon before death (hazard ratio: 0.46 [0.34, 0.62], p < .001). Though there were no differences in aneurysm size at time of surgical repair, patients in the lowest socioeconomic quartile were more frequently symptomatic at surgery than other quartiles (92% vs. 23%-38%, p < .001).<br />Conclusion: Patients with lower SES receive less timely follow-up imaging and specialist referral for TAAs, resulting in surgical intervention only when alarming symptoms are already present.<br /> (© 2021 Wiley Periodicals LLC.)
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