A dedicated toolkit has made it safer to be an aortic dissection patient in England today than it was before the project’s 2022 launch, but there is still work to be done, Rachel Bell (Freeman Hospital, Newcastle, UK) informed attendees at a recent dissection meeting.
Addressing delegates at the inaugural Interdisciplinary Aortic Dissection Symposium (IADS; 6 September; London, UK), Bell delivered an update on the National Health Service (NHS) England Acute Aortic Dissection Toolkit—designed to improve care for emergency acute aortic dissection patients—highlighting areas of progress, room for improvement, and future challenges.
The toolkit, which represents a collaboration between several specialties, has a core set of seven key principles, which Bell listed as regional governance, coordination through multidisciplinary teams, regional rotas with a single point of contact, timely image transfer, safe interhospital patient transfer, specialist treatment for all acute aortic dissections, and a regional educational programme.
Bell, an aortic specialist in the North East of England and Yorkshire, noted that the project has aimed from the outset to recognise regional differences across England. “London is full of specialists who deal with aortic dissection,” the presenter told the London gathering, “but as you move north, that degree of specialisation is less concentrated.” To address this, Bell detailed that the toolkit recognises seven distinct regions, each with their own vascular surgery and cardiac surgery leads.
Reflecting on one of the standout successes of the project to date, Bell stressed that there has been a “healthy national dialogue” around the toolkit’s key principles. “It’s been incredibly powerful getting people in a room and talking about the problems they have in their own regions,” she said, noting that representatives from the seven regions are now meeting on a monthly basis.
More specifically with regard to progress, the presenter reported that the North West, South of England and London now have published rotas for aortic dissection specialists and that the East of England has funded an aortic dissection coordinator.
In the North East, Bell shared that the team is about to launch a new regional picture archiving and communication system (PACS). As a result, A&E computed tomography (CT) scans will be available immediately, which Bell remarked will be “enormously helpful”. Similarly, in the South East, the team is testing is testing a cross-regional image transfer system.
Additionally, the presenter detailed that several aortic centres have started using a referral management systems—like Patient Pass and Referapatient—to ensure that the new pathways are followed and patients are referred rapidly to the correct centres.
“Lots of regions have done really well,” Bell summarised, highlighting the South of England—led by vascular surgeon Marcus Brooks (North Bristol NHS Trust, Bristol, UK) and cardiac surgeons Jonathan Hyde (Royal Sussex County Hospital, Brighton, UK) and George Krasopoulos (Oxford University Hospitals NHS Foundation Trust, Oxford, UK)—as “best in class” thanks to the team’s development of a supraregional standard operating procedure document.
As well as the headline successes, Bell also touched on some areas for growth. The presenter highlighted, for example, the ongoing difficulties of data collection overall but particularly for type B aortic dissection (TBAD) patients. This is because most TBADs are treated medically initially, and procedures are much easier to count.
Bell shared that data from the National Clinical Improvement Programme (NCIP) reveal a “poor” three-year mortality rate amongst those patients treated medically for TBADs, reaching 32%. She noted that this may represent an opportunity to improve medical treatment and surgical intervention for TBAD under follow-up and that this will need to be tackled in the ‘elective’ pathway.
In addition, Bell noted ongoing problems with image transfer and safe interhospital transfer. Here, the presenter referenced notable regional disparities. “As you get higher and higher up the country, there’s less support for appropriate interhospital transfer,” she said, specifying that in the North East the interhospital transfer is not provided 24/7.
Finally, Bell highlighted future opportunities around research. She mentioned in particular the UK-specific EARNEST trial, which is set to commence recruitment in March 2025. The study, Bell explained, “hopefully will answer some questions about what we do with those patients who are initially treated medically but we think may benefit from endovascular intervention in the sub-acute phase, and whether that will make a difference to their longer-term mortality.”
Concluding her presentation, Bell was keen to stress that the work is far from done. “Please don’t become complacent—we’ve got lots to improve, and we’ve still got the elective pathway to tackle,” she said. All this, Bell pointed out, against the backdrop of a rising incidence of aortic dissection.
However, the presenter also highlighted the “significant progress” made over the last two years, reiterating in particular the positive impact of communication. “I think the big message is don’t underestimate the power of talking and raising awareness nationally—it’s really made a difference.”
