Stories

Publication by Dr. Robert Berry. 

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Abstract

Background

Several specialties treat thoracic aorta disease, resulting in multiple patient care pathways. This study aimed to characterize these varied care models to guide health policy.

Methods

A 57-question e-survey was sent to staff cardiac surgeons, cardiologists, interventional radiologists and vascular surgeons at 7 Canadian medical societies.

Results

For 914 physicians, the response rate was 76% (86/113) for cardiac surgeons, 40% (58/146) for vascular surgeons, 24% (34/140) for radiologists and 14% (70/515) for cardiologists. Several services admitted Type B dissections (vascular 37%, cardiology 31%, cardiac 18%, other 7%) and care was heterogeneous. Ownership of disease management was overestimated relative to the perspective of the other specialties. Type A dissection admissions and treatment were more uniform but emergent call coverage varied. A 24/7 aortic specialist on-call schedule was only present 4% of the time. “Aortic” case rounds promoted attendance by a broader aortic specialty contingency relative to rounds that were specialty specific. Though 89% of respondents felt an aortic team was best for patient care only 54% worked at an institution with an aortic team present, and only 28% utilized an aortic clinic. Defining an aortic team derived 63 different combinations.

Conclusion

Thoracic aortic disease follows a network of undefined and variable care pathways, despite its high-risk population in need of complex treatment considerations. Multidisciplinary aortic teams and clinics exist in low volume and the ‘Aortic Team’ remains an obscure construct. A multispecialty initiative to define the Aortic Team and outline standardized navigation pathways within the health systems hospitals is advocated.