Ensuring equity in acute aortic syndrome treatment

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Abstract Introduction Equity in the health care system is one of the main goals. Therefore, the design of strategies to ensure equity should be pursued in any process reengineering. Acute aortic syndrome (AAS) encompasses a group of rare pathologies with high morbidity and mortality. Purpose The aim of the present study was to evaluate the prognostic impact of a specific healthcare network for AAS patients on those patients from the referring hospitals compared to those admitted directly to the tertiary care referral hospital. Methods The "Aorta Code" (AC) is a protocol for AAS-patients’ care within a network of 4 hospitals with a tertiary hospital as a referral center. A common diagnostic algorithm was specifically designed and periodical training programs were carried out in the different emergency departments at the 4 hospitals. Once activated, the out of hospital emergency service immediately transfers the patient to the Acute Cardiovascular Care Unit at the referral center. An Aortic Dissection Team was responsible for patients’ care. All patients with AAS were prospectively and consecutively collected. For the purposes of the present study patients from the peripheral referring hospitals were compared to those directly admitted to the referral center. Results Between 2019-2024, 142 patients with AAS were included. Most of them were diagnosed in peripheral centres (64.1% n=91), while 35.9% (n= 51) were admitted directly to the referral hospital. Mean age (66.9 ± 14.9 years, p=1), baseline characteristics and clinical presentation were similar in both groups (Table 1). Type A AAS was the most frequent (71.3%, n= 101) and aortic dissection the most common subtype (93.1%) with no diagnosis differences between centres (p=0.259). There were no significant differences in the proportion of surgically treated type A AAS patients (87.5% vs 72.6%, p=0.074) between groups. Although the time from first medical contact to surgery was longer in transferred patients (Figure 1), there were no differences in postoperative complications or 30-day or in-hospital mortality between the two groups (Table 1). Conclusion The reorganization of AAS care with the active involvement of all professionals reinforces the equity of care for AAS patients. The results in terms of complications and mortality of AAS were similar regardless of the centre of origin.AAS Diagnostic times (median in hours)

Ce résumé expose les affirmations des auteurs. BNTIC ne l’interprète pas comme une validation indépendante des résultats.