Barriers to Follow-up for Patients With Aortic Dissection in an Academic Tertiary City Hospital

Abstract

Proper follow-up after diagnosis and treatment of aortic dissection (AD) is important. Secondary problems like aneurysmal degeneration leading to rupture, stenosis, evolution of the dissection flap, and aortic remodeling can develop after treatment. Patients often have various barriers that hinder them from following up with their vascular or cardiothoracic surgeon. We sought to identify compliance with and barriers to surveillance in this population of patients. Retrospective chart review of 400 patients with AD between 2008 and 2018 at Thomas Jefferson University Hospital was performed. Of 400 patients, 313 had AD (DeBakey type I, II, or III). Demographics and risk factors were identified and recorded. After Institutional Review Board approval was obtained, patients were surveyed by telephone using an AD questionnaire assessing the type of intervention they had (open, endovascular, or medical) and whether they had seen a surgeon after treatment of their AD. Patients unable to follow up were questioned about obstacles to care. Descriptive statistics were calculated and reported on the basis of 100 preliminary patient records that were surveyed of 313. At the time of the survey, 88 patients were alive. Average age at the date of presentation to the hospital was 61.5 ± 14.9 years, with male predominance of 60%. Among these patients, 24% had DeBakey type I, 16% had type II, and 60% had type III; 33% were managed by open operation, 14% by endovascular approach, and 53% medically as deemed appropriate by diagnoses. Ninety-five patients were called (5 had missing contact information); 60 (63.2%) patients responded, 34 (35.7%) could not be reached, and 1 (1.1%) refused to participate. Twenty-five (26.3%) had been to their surgeon, and 35 (36.8%) did not follow up. Of 95 patients, 55 (57.9%) reported that they understood the need for follow-up, and 5 were unaware of the need for further care. Patients reported lack of escort (3.6%), anxiety related to diagnosis (3.6%), chronic medical illness (7.1%), age-related weakness (1.2%), lack of transportation (4.8%), transportation costs (2.4%), employment obligations (1.2%), inability to pay for visits (7.2%), and scheduling issues (9.5%). The remaining patients thought they did not need to see their surgeon (44%). Preliminary data show that a majority of patients do not seek follow-up with a surgeon after the diagnosis and management of AD. It is crucial that there are guidelines in place to address issues of access to care and to prevent potential future complications in these patients. Survey of all patients will be completed before the Vascular Annual Meeting.