Abstract 20595: Aortic Dissection

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Abstract

Introduction: Patients with aortic dissection (AD) remain at risk for long term (LT) complications. All patients treated through a multi-disciplinary center were recommended to closely adhere to routine ACC/AHA aorta guideline based follow up (f/u) imaging and clinic visits. (q 3 months first year and annually thereafter). The long term (LT) outcome of such a model has not been previously evaluated.

Methods: Patients surviving hospital discharge were grouped by compliance with recommended follow up into three separate groups: low, intermediate and high f/u (< 33%, 34-67%, and > 67%). At f/u visit, medication use was documented.

Results: Since 2005, 168 patients (66% type A, 34% type B) with AD surviving hospital discharge were grouped by degree of f/u: low (n=55), intermediate (n=48) and high (n=65). These 3 groups were similar with regards to age (63 ±15 years), gender (60% M), dissection type and risks including tobacco (30%), hypertension (76%), diabetes (9%), renal disease (18%) and Marfan syndrome (7%). The three groups did differ with the low f/u group less likely treated with beta blocker (77%, 98%, and 94% in low, intermediate, and high f/u groups respectively) (p = 0.002) and ARB use (11%, 36%, and 15% ,p = 0.008). Calcium channel blocker (53%) and ACE inhibitor (39%) use were similar. LT survival didn’t differ by dissection type. Survival was improved in those more compliant with f/u :5 year survival (64%, 91%, and 84%, low, intermediate and high)(p = 0.002). (Figure)

Conclusion: Patients treated at an AD center where regular f/u is emphasized differ in regards to compliance with f/u with 1/3 of the population adhering to < 1/3 of recommended f/u visits. Patients with lower f/u compliance are demonstrated to have lower use of recommended beta blocker use and lower LT survival. Efforts to increase compliance with guideline recommended f/u and medication use after AD may lead to improved LT survival.

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