P5599Prognostic impact of quality indicators on outcomes of acute aortic dissection in Japan

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
T Yamaguchi ◽  
M Nakai ◽  
Y Sumita ◽  
Y Miyamoto ◽  
H Matsuda ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Hospital Mortality ◽  
Quality Indicators ◽  
Acute Aortic Dissection ◽  
Vascular Diseases ◽  
Type A ◽  
Administrative Database ◽  
Type B ◽  
Practice Gaps

Abstract Background Despite recent advances in diagnosis and management, the mortality of acute aortic dissection (AAD) remains high. Purpose This study aims to develop quality indicators (QIs) for the management of AAD, and to evaluate the associations between QIs and outcomes of AAD in a Japanese nationwide administrative database. Methods A total of 18,348 patients suffered from AAD (Type A: 10,131, Type B: 8,217) in the Japanese Registry of All Cardiac and Vascular Diseases database between 2012 and 2015 were studied. A systematic review was performed to establish initial index items for QIs. Evaluation was performed through the expert consensus meeting using a Delphi method. Associations between developed QIs and the mortality were determined by multivariate mixed logistic regression analyses. Results A total of nine QIs (five structural and four processatic) were developed. Achievements of developed QIs (High: 7–9, Middle: 4–6, Low: 0–3) were significantly associated with lower in-hospital mortality even after adjustment for covariates in both type A (Middle: odds ratio [OR], 0.257; 95% confidence interval [CI], 0.211–0.312; P<0.001; High: OR, 0.064; 95% CI, 0.047–0.086; P<0.001 vs. Low) and type B (Middle: OR, 0.447; 95% CI, 0.338–0.590; P<0.001; High: OR, 0.128; 95% CI, 0.077–0.215; P<0.001 vs. Low). Additionally, achievements of structural and processatic QIs were consistently associated with reduced in-hospital mortality. QIs and in-hospital mortality Conclusions Developed QIs for AAD management were significantly associated with lower in-hospital mortality. Evaluation of each hospital's management with QIs could be helpful to equalize quality of treatment and to fill the evidence-to-practice gaps in the real-world treatment.

scholarly journals Impact of structural and process quality indicators on the outcomes of acute aortic dissection

2020 ◽  
Vol 58 (6) ◽  
pp. 1281-1288
Author(s):  
Tetsuo Yamaguchi ◽  
Michikazu Nakai ◽  
Yoko Sumita ◽  
Yoshihiro Miyamoto ◽  
Hitoshi Matsuda ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Hospital Mortality ◽  
Quality Indicators ◽  
Real World ◽  
Acute Aortic Dissection ◽  
Type A ◽  
Sensitivity Analyses ◽  
Administrative Database ◽  
Type B ◽  
Practice Gaps

Abstract OBJECTIVES The mortality of acute aortic dissection (AAD) remains high, and evidence-to-practice gaps exist in real-world treatment. We explored the first quality indicators (QIs) for AAD management and evaluated the associations between the achievement of these QIs and the outcome in a nationwide administrative database. METHODS A systematic search was performed to establish initial index items for QIs. An evaluation was performed through an expert consensus meeting using the Delphi method. We studied 18 348 patients who had AAD (type A: 10 131; type B: 8217) in the Japanese Registry of All Cardiac and Vascular Diseases database between April 2012 and May 2015. The associations between the achievement of QIs [categorized into tertiles (low, middle and high)] and in-hospital mortality were determined by multivariable mixed logistic regression analyses. RESULTS AND CONCLUSION We developed a total of 9 QIs (5 structural and 4 process). Lower achievement rates of QIs were significantly associated with higher in-hospital mortality in both types [type A = middle: odds ratio (OR) 4.03; 95% confidence interval (CI) 3.301–4.90; P &lt; 0.001; low: OR 15.68; 95% CI 11.67–21.06; P &lt; 0.001 vs high; type B = middle: OR 3.48; 95% CI 2.19–5.53; P &lt; 0.001; low: OR 7.79; 95% CI 4.65–13.06; P &lt; 0.001 vs high]. Various sensitivity analyses showed consistent results. High achievement rates of QIs were significantly associated with reduced in-hospital mortality. Evaluating each hospital’s management using QIs would help to equalize treatment quality and demonstrate the evidence-to-practice gaps in real-world treatments for AAD.

scholarly journals Prevalence, Clinical Features, and In-hospital Outcome of Fatty Liver Disease in Acute Aortic Dissection: A Single-Center Retrospective Study

2021 ◽  
Vol 8 ◽  
Author(s):  
Yifan Zuo ◽  
Xin Cai ◽  
Zhiwei Wang ◽  
Zhipeng Hu ◽  
Zhiyong Wu ◽  
...  
Keyword(s):  
Liver Disease ◽  
Aortic Dissection ◽  
Hospital Mortality ◽  
Fatty Liver ◽  
Clinical Features ◽  
Fatty Liver Disease ◽  
Acute Aortic Dissection ◽  
Type A ◽  
Type B ◽  
Hospital Outcome

Background and Aims: Fatty liver disease (FLD) has emerged as a major public issue in China. We aim to investigate prevalence, clinical features, and in-hospital outcome of FLD in acute aortic dissection (AAD) patients.Methods: Data of 379 AAD patients from 2017 to 2019 at Renmin hospital of Wuhan University was retrospectively collected and divided according to age and FLD absence. Propensity score matching was used for minimal confounding. We compared their physical environmental parameter of onset, clinical features, and in-hospital outcome.Results: The mean age was 52.0 ± 11.5 years in type A and 55.1 ± 11.4 in type B. 25.0% of type A and 19.2% of type B AAD patients had FLD. Logistic regression indicated a negative association between FLD and age, both in type A [unadjusted odds ratio (OR) 0.958 (per 1 year), 95% confidence interval (CI) 0.930–0.988, p = 0.0064] and type B [unadjusted OR 0.943 (per 1 year), 95% CI 0.910–0.978, p = 0.0013]. After matching, type A with FLD had onset with a lower air quality index (AQI) of 68.5 [interquartile range (IQR) 46.0–90.0] and a lower Pm 2.5 concentration of 36.0 μg/m3 (IQR 23.0–56.0) compared with non-FLD group. In Kaplan-Meier estimation, FLD was associated with higher risk of in-hospital mortality in type B AAD (p = 0.0297).Conclusion: The prevalence of FLD in AAD decrease with age, both in type A and type B AAD. Type A AAD patients with FLD had onset with better air quality parameters compared with non-FLD group. FLD was associated with higher risk of in-hospital mortality in type B AAD.

P5607Clinical characteristics and treatment strategy for acute aortic dissection in Tokyo Acute Aortic Disease Super-Network System

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
H Yoshino ◽  
K Akutsu ◽  
T Takahashi ◽  
T Shimokawa ◽  
H Ogino ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Hospital Mortality ◽  
Treatment Strategy ◽  
Acute Aortic Dissection ◽  
False Lumen ◽  
Type A ◽  
Network System ◽  
Care Hospital ◽  
Type B ◽  
New System

Abstract Introduction Acute aortic dissection (AAD) is one of the most fatal cardiovascular diseases. The prevalence of AAD is reported to be low. The clinical data of AAD from representative cardiovascular centers are not enough to show the whole range of clinical feature of AAD. We have to know the exact prevalence and clinical pictures of AAD under the new system, the Tokyo AAD Super-Network System (TAAD-SNS), for strategy of emergency transport and treatment of AAD which would cover the entire metropolitan area of Tokyo. TAAD-SNS started in 2011, and after slight modification, the new system of AAD re-started in 2013. The aim of this study is to elucidate the whole range of clinical characteristics and recent trends of treatment of AAD. Methods Out of 73 hospitals included in Tokyo CCU Network system, 41 hospitals are chosen for TAAD-SNS. These hospitals provide around-the-clock surgery. In this system, the availability of surgical division is monitored in real time. All of the patients suspected of AAD are transferred directly or from primary care hospital to the hospitals of TAAD-SNS. Results After exclusion of 237 patients with cardiopulmonary arrest on arrival, 4877 consecutive patients (2923 male, mean age of 69±14 y/o) were admitted to the hospitals with diagnosis of AAD from 2013 to 2016. Prevalence of AAD in Tokyo was about 10 patients per 100,000 populations in every year. After exclusion of 37 patients undetermined into type A or B, 4840 patients (2694 with type A and 2146 with type B) were analyzed. Among the type A patients, 1752 (65%) were classified into type of patent false lumen (classic-type), 721 (27%) of closed false lumen (intramural hematoma: IMH-type), and 221 (8%) were undetermined. Among the type B, 880 (41%) were classified into classic-type, 1129 (53%) of IMH-type, and 137 (6%) were undetermined. Both among type A and B, mean ages were younger in classic-type than in IMH-type (type A: 66±14 vs. 73±12 y/o, p<0.05; type B: 64±15 vs. 72±12 y/o, p<0.05). Prevalence of male population and risk factor of hypertension was higher in type B than in type A both among classic-type and IMH-type. Systolic blood pressure at the emergency room was lower in type A than in type B among both classic-type and IMH-type (classic-type: 124±34 vs. 161±38 mmHg, IMH-type: 130±51 vs. 163±56 mmHg). In-hospital mortality of surgical treatment for type A classic-type and type A IMH-type, conservative strategy for type B classic-type and type B IMH-type was 9.6%, 4.2%, 3.1% and 1.7%, respectively. Stentgraft implantation for type B AAD started and shows a favorable in-hospital mortality compared to the operative treatment (Stentgraft vs. surgery in type B classic-type: 7.8% vs. 6.5%, in type B IMH-type: 10.7% vs. 11.8%, respectively). Conclusion Our study showed that prevalence of AAD was 2–3 times higher than previous reports. We should consider to choose the treatment strategy according to the type of AAD, A or B, classic-type or IMH-type. Acknowledgement/Funding Tokyo Metropolitan government

Incidence and risk factors of recurrent pain in acute aortic dissection and in-hospital mortality

VASA ◽  
2018 ◽  
Vol 47 (4) ◽  
pp. 301-310
Author(s):  
Dilixiati Siti ◽  
Asiya Abudesimu ◽  
Xiaojie Ma ◽  
Lei Yang ◽  
Xiang Ma ◽  
...  
Keyword(s):  
Risk Factors ◽  
Aortic Dissection ◽  
Hospital Mortality ◽  
Acute Aortic Dissection ◽  
Emergency Operation ◽  
Type A ◽  
Type B ◽  
Recurrent Pain ◽  
Group I ◽  
Group Ii

Abstract. Background: We investigated the prevalence of recurrent pain and its relationship with in-hospital mortality in acute aortic dissection (AAD). Patients and methods: Between 2011 and 2016, 234 AAD patients were selected. Recurrent pain was defined as a mean of VAS > 3, within 48 hours following hospital admission or before emergency operation. Patients with and without recurrent pain were divided into group I and group II, respectively into type A AAD and type B AAD patients. Our primary outcome was in-hospital mortality. Results: The incidence of recurrent pain was 24.4 % in AAD patients. Incidence of recurrent pain was higher in type A AAD patients than type B AAD patients (48.9 vs. 9.6 %). Overall in-hospital mortality was 25.6 %. Type A AAD had a higher in-hospital mortality than type B AAD patients (47.7 vs. 12.3 %). Group I had significantly higher in-hospital mortality than group II (type A: 79.1 vs. 17.8 %; type B: 57.1 vs. 7.6 %, all P < 0.001), as was the case with medical managed patients (type A: 72.1 vs. 13.3 %; type B: 35.7 vs. 2.3 %, all P < 0.001). Logistic regression analysis showed that use of one drug alone and waist pain were predictive factors for recurrent pain in type A AAD and type A AAD patients, respectively (OR 3.686, 95 % CI: 1.103~12.316, P = 0.034 and OR 14.010, 95 % CI: 2.481~79.103, P = 0.003). Recurrent pains were the risk factors (type A: OR 11.096, 95 % CI: 3.057~40.280, P < 0.001; type B: OR 14.412, 95 % CI: 3.662~56.723, P < 0.001), while invasive interventions were protective (type A: OR 0.133, 95 % CI: 0.035~0.507, P < 0.001; type B: OR 0.334, 95 % CI: 0.120~0.929, P = 0.036) for in-hospital mortality in AAD patients. Conclusions: Approximately one-fourth of AAD patients presented with recurrent pains, which might increase in-hospital mortality. Thus, interventional strategies at early stages are important.

scholarly journals Current status of the management and outcomes of acute aortic dissection in Japan: Analyses of nationwide Japanese Registry of All Cardiac and Vascular Diseases-Diagnostic Procedure Combination data

2019 ◽  
Vol 9 (3_suppl) ◽  
pp. S21-S31 ◽  
Author(s):  
Tetsuo Yamaguchi ◽  
Michikazu Nakai ◽  
Yoko Sumita ◽  
Yoshihiro Miyamoto ◽  
Hitoshi Matsuda ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Acute Aortic Dissection ◽  
Vascular Diseases ◽  
Type A ◽  
Primary Diagnosis ◽  
Current Status ◽  
Type B ◽  
Japanese Yen ◽  
Aortic Dissections ◽  
Autumn And Winter

Background: Despite recent advances in the diagnosis and management, the mortality of acute aortic dissection remains high. This study aims to clarify the current status of the management and outcome of acute aortic dissection in Japan. Methods: A total of 18,348 patients with acute aortic dissection (type A: 10,131, type B: 8217) in the Japanese Registry of All Cardiac and Vascular Diseases database between April 2012–March 2015 were studied. Characteristics, clinical presentation, management, and in-hospital outcomes were analyzed. Results: Seasonal onset variation (autumn- and winter-dominant) was found in both types. More than 90% of patients underwent computed tomography for primary diagnosis. The overall in-hospital mortality of types A and B was 24.3% and 4.5%, respectively. The mortality in type A patients managed surgically was significantly lower than in those not receiving surgery (11.8% (799/6788) vs 49.7% (1663/3343); p<0.001). The number of cases managed endovascularly in type B increased 2.2-fold during the period, and although not statistically significant, the mortality gradually decreased (5.2% to 4.1%, p=0.49). Type A showed significantly longer length of hospitalization (median 28 days) and more than five times higher medical costs (6.26 million Japanese yen) than those in type B. The mean Barthel index at discharge was favorable in both type A (89.0±22.6) and type B (92.6±19.0). More than two-thirds of type A patients and nearly 90% of type B patients were directly discharged home. Conclusions: This nationwide study elucidated the clinical features and outcomes in contemporary patients with acute aortic dissections in real-world clinical practice in Japan.

scholarly journals Effect of holiday admission for acute aortic dissection on in-hospital mortality in Japan: A nationwide study

PLoS ONE ◽  
2021 ◽  
Vol 16 (11) ◽  
pp. e0260152
Author(s):  
Katsuhito Kato ◽  
Toshiaki Otsuka ◽  
Michikazu Nakai ◽  
Yoko Sumita ◽  
Yoshihiko Seino ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Hospital Mortality ◽  
Acute Aortic Dissection ◽  
Vascular Diseases ◽  
Type A ◽  
Weekend Effect ◽  
Increased Risk ◽  
Multi Level ◽  
Stratified Analysis ◽  
Stanford Type B

Background Patients admitted on weekends have higher mortality than those admitted on weekdays. However, whether the “weekend effect” results in a higher mortality after admission for acute aortic dissection (AAD),—classified according to Stanford types—remains unclear. This study aimed to examine the association between admission day and in-hospital mortality in AAD Type A and B. Methods We used data from the Japanese registry of all Cardiac and Vascular Diseases Diagnostic Procedure Combination, a nationwide claim-based database with data from 953 certified hospitals, and enrolled in-patients with AAD admitted between April 1, 2012, and March 31, 2016. Based on the admission day, we stratified patients into groups (Weekdays, Saturdays, and Sundays/holidays). The influence of the admission day on in-hospital mortality was assessed via multi-level logistic regression analysis. We also performed a Stanford type-based stratified analysis. Results Among the included 25,641 patients, in-hospital mortality was 16.0%. The prevalence of patients admitted with AAD was relatively higher on weekdays. After adjustment for covariates, patients admitted on a Sunday/holiday showed an increased risk of in-hospital mortality (odds ratio [OR] 1.20; 95% confidence interval [CI] 1.07–1.33, p<0.001) than patients admitted on weekdays. Among patients admitted on a Sunday/holiday, only the subgroup of Stanford Type A showed a significantly increased risk of in-hospital mortality. (Stanford Type A, non-surgery vs. surgery groups: 95% CI 1.06–1.48 vs. 1.17–1.68, p<0.001 for both groups, OR 1.25 vs. 1.41, respectively, Stanford Type B, non-surgery vs. surgery groups: 95% CI 0.64–1.09 vs. 0.40–2.10; p = 0.182 vs. 0.846; OR 0.84 vs. 0.92). Conclusions In conclusion, patients with AAD Type A admitted on a Sunday/holiday may have an increased in-hospital mortality risk.

The short-term prognostic value of serum platelet to hemoglobin in patients with type A acute aortic dissection

Perfusion ◽  
2020 ◽  
pp. 026765912098222
Author(s):  
Yu Wang ◽  
Tengfei Qiao ◽  
Jun Zhou
Keyword(s):  
Aortic Dissection ◽  
Hospital Mortality ◽  
Acute Aortic Dissection ◽  
Independent Predictor ◽  
Type A ◽  
Short Term ◽  
Survivor Group ◽  
Mortality Hazard ◽  
Mortality Hazard Ratio ◽  
The Ideal

Purpose: Type A acute aortic dissection (AAD) is an uncommon catastrophic cardiovascular disease with high pre-hospital mortality rate without timely and effectively treated. The aim of this study was to assess the value of serum platelet to hemoglobin (PHR) in predicting in-hospital mortality in type A AAD patients. Methods: A total of 183 type A AAD patients were included in this retrospective investigation from January 2017 to December 2019. Admission blood routine parameters were gathered and PHR was computed. The outcome was all-cause in-hospital mortality within 30 days. Results The average levels of serum PHR were significant higher in survivor group than those in non-survivor group (1.14 ± 0.57 vs 0.87 ± 0.47, p = 0.006) and serum PHR was an independent factor associated with in-hospital mortality (hazard ratio (HR): 2.831; 95% confidence interval (CI): 1.108–7.231; p = 0.030). ROC noted that 0.8723 was chosen as the ideal cutoff value with a sensitivity of 64.3% and specificity of 72.5%. In addition, the area under the ROC curve (AUC) was 0.693 (95% CI 0.599–0.787, p < 0.001). Conclusion: Admission serum PHR can be used as an independent predictor of in-hospital mortality in patients with type A AAD.

Abstract TP144: Mechanisms And Prognosis Of Acute Ischemic Stroke Related To Acute Aortic Dissection

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Seung-Jae Lee ◽  
Dong-Suk Shim ◽  
Si-Ryung Han
Keyword(s):  
Ischemic Stroke ◽  
Aortic Dissection ◽  
Early Onset ◽  
Acute Aortic Dissection ◽  
Type A ◽  
Posterior Circulation ◽  
Type B ◽  
Delayed Onset ◽  
Bilateral Carotid ◽  
Type B Dissection

Background: Acute aortic dissection (AD) is one of the lethal cardiac diseases involving the aorta. Although pain is a typical symptom, stroke may not rarely occur with the occlusive dissection of aortic branches or hypotension under the condition of AD. We attempted to explores the clinical features, possible mechanisms and prognosis of acute ischemic stroke (AIS) related to AD Method: Medical records of 278 consecutive patients with AD (165 with type A and 113 with type B dissection) over 11.5 years were retrospectively analyzed for clinical history, CT or MRI findings and outcome. AIS were categorized into early- or delayed-onset stroke. Early-onset stroke was defined as an AIS presented at admission, and delayed-onset stroke was an AIS which were developed during the two months after the first admission. Results: 26 (9.4%) patients experienced an ischemic stroke, which included 22 with type A and 4 with type B dissection. 8 patients (2.9%) including a case of TIA had an early-onset stroke, whereas delayed-onset stroke occurred in 18 patients (6.5%) postoperatively or under medical treatment. Early-onset stroke was all referable to the anterior circulation, predominantly right-sided (87.5%). One or more main branches of the aortic arch were involved in 6 out of 8 patients (75%) with early-onset stroke. Innominate artery was most frequently involved (75.0%). In contrast, delayed-onset stroke affected similarly bilateral carotid territories, and also included lesions in bilateral carotid, posterior-circulation and anterior/posterior-circulation territories. Among the 26 patients, 8 patients (30.8%) expired within 6 months of the disease onset (3 cases from hemispheric stroke with brain herniation, 2 cases from aortic rupture, 2 cases from sepsis with multiple organ failure and a case from mesentery ischemia and renal failure). Additionally, 9 patients (34.6%) remained functionally dependent six months later. Conclusion: AD not infrequently causes AIS with grave prognosis, especially in patients with type A dissection. The presumed mechanisms were aortic branch dissection causing luminal occlusion and emboli from thrombosed vascular lumen and hypotension under the condition of AD.

scholarly journals Bilateral testicular pain as an acute aortic dissection symptom

2016 ◽  
Vol 64 (3) ◽  
pp. 571 ◽  
Author(s):  
Gloria Mercedes Guarín-Loaiza ◽  
Laura Cristina Nocua-Báez ◽  
Gladys Alfonso-Hernández
Keyword(s):  
Health Care ◽  
Mortality Rate ◽  
Aortic Dissection ◽  
Early Identification ◽  
Acute Aortic Dissection ◽  
Type A ◽  
Type B ◽  
Anatomical Distribution ◽  
Testicular Pain ◽  
Great Vessels

Acute aortic dissection is a serious cardiovascular event and the most common acute disease of the great vessels. According to the anatomical distribution of the compromised aorta, the Stanford Group classifies it into type A and type B. Its prognosis depends on its early identification and treatment, as the mortality rate in type A increases rapidly with each hour of delay of diagnosis.Clinical manifestations of aortic dissection may be varied, which makes its early diagnosis difficult. Regarding its diagnosis, genital pain is one of the rarest symptoms. In this paper, the case of a patient who initially attended a health care institution due to acute bilateral testicular pain and was eventually diagnosed with acute aortic dissection is presented.

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