“The incidence of acute aortic dissection in England is rising,” Arun Pherwani (University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, UK) told the 2024 Charing Cross (CX) International Symposium (23–25 April, London, UK). Pherwani delivered this statement among other key findings as part of a podium-first presentation on outcomes of acute aortic dissection in the UK.
Pherwani, who included on a list of disclosures his role as clinical lead for the National Vascular Registry (NVR) and the joint clinical lead for the National Consultant Information Programme (NCIP) Vascular Surgery , first underlined “one of the biggest problems with aortic dissections”. This, he added, is the fact that there is a single code on the International Classification of Diseases 10 that codes all aortic dissections, irrespective of which section of the aorta is dissected, or where the entry tear is. “That’s why it’s very hard to find data—real data, national data—on aortic dissections,” Pherwani said.
As part of the National Consultant Information Programme (NCIP), Pherwani and colleagues decided to “hit on a novel strategy” to collect data, whereby they picked up every single admission in England as an emergency with a diagnostic code of aortic dissection. “So, we focused on the condition rather than the procedures that were done,” he outlined.
The researchers used Hospital Episode Statistics (HES) data from November 2017 to October 2022 to capture the outcomes of all aortic dissections in the United Kingdom during this time period. The project, he remarked, represents a unique collaboration of the vascular NCIP, cardiac NCIP, NVR and National Institute for Cardiovascular Outcomes Research (NICOR).
Over the five-year study period, Pherwani and colleagues identified 6,994 patients with aortic dissection admitted to English hospitals. Those with previous repair (n=76) were excluded, leaving 6,918 patients to be analysed. “Of these,” he detailed, “the ones who underwent a type A operation were just under 40%, who underwent a procedure for type B were 8.8%, and the majority were patients who we’ve loosely clubbed [together] as medically treated. This will include patients who were palliated, and even palliated patients who presented with type A aortic dissections.”
Pherwani compared these data to some from the NVR, noting that there are currently data available for a six-year period available—2016–2021—covering 540 procedures for type B aortic dissection (TBAD). The majority of these (97%) were thoracic endovascular aortic repairs (TEVAR). Pherwani shared that overall mortality among the patients treated was 8.9%, 11.1% were treated as emergencies, and that there were no data on medically treated TBAD.
The presenter then focused on HES and its role as NCIP’s key data source for procedure dashboards. Specifically, he addressed the question of why the NCIP uses HES for admitted patient care. Pherwani listed various reasons, including its ready availability and the fact that it offers complete coverage of activity. Furthermore, he continued, HES is linkable for longitudinal analyses, has a standardised format, and is good for hard outcomes, including hospital mortality, length of stay, readmission, and reoperation.
“Data quality is NCIP’s biggest priority,” Pherwani commented.
“In conclusion,” Pherwani said, “this is the first unbiased report of all-comers with all types of aortic dissection using national data from England.” He informed the audience that these are not bespoke registry data on TEVAR for either uncomplicated or complicated TBAD alone, and that the incidence of dissection is rising.
“This methodology is reproducible in other nations,” the presenter added.
Closing his presentation, Pherwani stated: “Whilst I’ve shown you some strengths and limitations of data from administrative sources, what I’ve also been able to show you is how to identify the study population for IMPROVE-AD, for SUNDAY, and for the EARNEST trials.”
In the discussion following Pherwani’s presentation, session anchor Ian Loftus (London, United Kingdom), asked whether there is inequality in access to surgical intervention in the United Kingdom.
“What we want to do and what we’re in the process of doing is producing data regionally for the [different] sections in England, which will tell us about equality of access to services,” Pherwani said in response.
Also in the discussion, Pherwani commented on the rising incidence of aortic dissection. “One of the reasons I think the incidence of aortic dissection is rising in the United Kingdom is because of the aortic dissection awareness campaigns.”
