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Socioeconomic Disparities in Surveillance and Follow-Up of Patients with Thoracic Aortic Aneurysm
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  • Michael Shang,
  • Gabe Weininger,
  • Makoto Mori,
  • Arianna Kahler-Quesada,
  • Ellelan Degife,
  • Cornell Brooks,
  • Matthew Williams,
  • Roland Assi,
  • Arnar Geirsson,
  • Prashanth Vallabhajosyula
Michael Shang
Yale School of Medicine
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Gabe Weininger
Yale School of Medicine
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Makoto Mori
Yale University School of Medicine
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Arianna Kahler-Quesada
Yale School of Medicine
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Ellelan Degife
Yale University School of Medicine
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Cornell Brooks
Yale School of Medicine
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Matthew Williams
Yale University School of Medicine
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Roland Assi
Yale University School of Medicine
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Arnar Geirsson
Yale University School of Medicine
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Prashanth Vallabhajosyula
Yale School of Medicine
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Abstract

Background: Thoracic aortic aneurysm is a significant risk factor for aortic dissection and rupture. Guidelines recommend referral of patients to a cardiovascular specialist for periodic surveillance imaging with surgical intervention determined primarily by aneurysm size. We investigated the association between socioeconomic status and surveillance practices in patients with ascending aortic aneurysms. Methods: We retrospectively reviewed records of 465 consecutive patients diagnosed between 2013-2016 with ascending aortic aneurysm ≥4cm on computed tomography scans. Primary outcomes were clinical follow-up with a cardiovascular specialist and aortic surveillance imaging within 2 years following index scan. We stratified patients into quartiles using the area deprivation index (ADI), a validated percentile measure of 17 variables characterizing socioeconomic status at the census block group level. Competing risks analysis was used to determine interquartile differences in risk of death prior to follow up with a cardiovascular specialist. Results: Lower socioeconomic status was associated with significantly lower rates of surveillance imaging and referral to a cardiovascular specialist. On competing risks regression, the ADI quartile with lowest socioeconomic status had lower hazard of follow-up with a cardiologist or cardiac surgeon prior to death (HR 0.46 [0.34, 0.62], p<0.001). Though there were no differences in aneurysm size at time of surgical repair, patients in the lowest socioeconomic quartile were more frequently symptomatic at surgery than other quartiles (92% vs 23-38%, p<0.001). Conclusion: Patients with lower socioeconomic status receive less timely follow-up imaging and specialist referral for thoracic aortic aneurysms, resulting in surgical intervention only when alarming symptoms are already present.

Peer review status:Published

04 Sep 2021Submitted to Journal of Cardiac Surgery
04 Sep 2021Assigned to Editor
04 Sep 2021Submission Checks Completed
04 Sep 2021Reviewer(s) Assigned
22 Sep 2021Review(s) Completed, Editorial Evaluation Pending
22 Sep 2021Editorial Decision: Accept
06 Dec 2021Published in Journal of Cardiac Surgery. 10.1111/jocs.16173