Clinical follow-up, surveillance imaging, and outcomes
Follow-up care information was collected from the Yale-New Haven Health EMR, which encompasses 5 acute care hospitals in academic and community settings and over 120 outpatient clinics at satellite locations throughout the state of Connecticut. In addition, we utilized information from Care Everywhere (Natick, MA), which allows enrolled patients to share visit notes and imaging reports from outside healthcare institutions (in- and out-of-state) with our institutional EMR.
We reviewed the EMR to determine if patients were presently being followed for ATAA aneurysm by a cardiologist and/or cardiac surgeon, at the time of index CT scan. In patients without pre-existing relationships with these specialists, we recorded the dates of first encounter for ATAA monitoring. In addition, we determined whether patients received follow-up echocardiography and/or chest CT (with or without contrast), as recommended by consensus guidelines, and for what indication (aneurysm surveillance vs. unrelated) prior to 12 months and 24 months post-index scan.4 These time intervals were chosen in light of evidence that annual surveillance imaging of moderate-size ATAA (<5cm) may be unwarranted.16 We also determined whether patients had undergone surgical repair of their aneurysm during the study period, and if so, the size of the ATAA and presence of related symptoms (chest/back pain, dyspnea, dysphagia) at the time of surgical evaluation.
The date of the index CT scan was used as the initial time point for the follow-up. Length of clinical follow-up was defined as time elapsed from the date of index CT scan identifying ATAA to the date of first review of the EMR (March 1, 2021) in living patients, or date of mortality in deceased patients.