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.