Study points to postcode lottery in aneurysm care

Posted by ap507 at Mar 14, 2017 09:09 AM |
BHF-funded research shows access to treatment varies from county to county

Issued by the British Heart Foundation on 13 March 2017

A postcode lottery in access to treatment means people suffering from thoracic aortic diseases are up to four times more likely to receive treatment in some parts of the UK compared to others, according to new research funded by the British Heart Foundation (BHF). This results in significant regional variation in treatment and mortality rates according to the study, published in the Journal of the American Heart Association.

A thoracic aortic aneurysm is the dangerous swelling and weakening of the aorta above the diaphragm. If untreated, an aneurysm is more likely to rupture or tear, which is fatal in 80 per cent of cases. An aneurysm is just one of several life-threatening diseases which fall into the category of thoracic aortic disease. If the wall of the aorta becomes weakened, it can: bulge causing an aortic aneurysm, tear causing an aortic dissection, or split– causing an aortic rupture. Around 6,000 people die of thoracic aortic disease in the UK every year.1

A BHF-funded team of researchers from the University of Leicester used data from the database for hospital epis[1]ode statistics (HES) to analyse 24,548 cases of thoracic aorta disease in England between financial years 2004/2005 and 2010/2011, and from the National Adult Cardiac Surgery Audit (NACSA), including 8,058 patients who received major aortic surgery between 1st of April 2007 and the 31st of March 2013.

The researchers looked at the proportion of patients that underwent treatment - either surgery or minimally invasive endovascular procedures - within six months of diagnosis. This allowed for any patients who had been allocated treatment to receive it. They found that the amount of people treated within this timeframe varied significantly between counties, from 7.6 percent in Leicestershire to 31.5 percent in the West Midlands.

When patients were treated, mortality rates did not vary significantly between counties. However, untreated patients were at a higher risk of death, meaning that the death rate for patients with thoracic aortic disease varied from county to county. For untreated patients mortality rates ranged from 19.6 per cent in Leicestershire to 36.8% in East Sussex, respectively.

Larger cardiac centres - which are more used to treating large numbers of patients with thoracic aortic disease – often treated patients with more complex aortic disease, with better outcomes. A parallel review of international studies evaluating best practice indicated that the delivery of care by multidisciplinary teams in high-volume units resulted in better outcomes.

The study is the first nationwide analysis of the quality and quantity of care for patients with thoracic aortic disease. However, the study does have limitations in that it relies on the accuracy of the HES and NACSA databases which depend upon clinicians and healthcare managers recording the treatment given.

Dr Giovanni Mariscalco, honorary Consultant Cardiothoracic and Adult Congenital Heart Surgeon at the University of Leicester, who led the research, said:

“This study has shown that patients across the country who have a potentially life-threatening thoracic aortic disease are not receiving equal treatment or consistent care.

“It is clear that, in some regions, patients will not receive treatment and will therefore be at a greater risk of dying as a result of their condition.

“Now that we have identified this issue, it is vital that changes are made to ensure that a patient suffering from a thoracic aneurysm in Newcastle receives the same level of treatment as a similar patient in Brighton.”

Professor Sir Nilesh Samani, Medical Director at the British Heart Foundation, which funded the research, said:

“These are potentially very important observations. Aortic diseases can be life-threatening if left untreated.

“Further research needs to be done to understand the reasons behind the apparently marked variation in the proportion of patients treated in different parts of the UK and any findings followed-up to minimise the variation so that patients throughout the country can be confident that they are receiving the most appropriate care.

“This analysis is another example of how access to de-identified data in our NHS for research and audit can help to identify important issues relevant to patient care.”

Find out how BHF-funded research is transforming the lives of people with heart and circulatory disease at bhf.org.uk/research

ENDS 

To request interviews or for more information please call the BHF press office on email newsdesk@bhf.org.uk.

Notes to editors

  1. von Allmen et al. Incidence of descending aortic pathology and evaluation of the impact of thoracic endovascular aortic repair: a population-based study in England and Wales from 1999 to 2010.  European Journal of Vascular and Endovascular Surgery

About the British Heart Foundation (BHF)

For over 50 years we’ve pioneered research that’s transformed the lives of people living with heart and circulatory conditions. Our work has been central to the discoveries of vital treatments that are changing the fight against heart disease. But so many people still need our help. From babies born with life-threatening heart problems to the many Mums, Dads and Grandparents who survive a heart attack and endure the daily battles of heart failure. Every pound raised, minute of your time and donation to our shops will help make a difference to people’s lives. For more information, visit bhf.org.uk.

 

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