Introduction: Acute Type A aortic Intramural Hematoma (IMH), a subgroup of aortic dissection, has evoked discussion regarding optimal management of this condition. While some centers have advocated for medical management, recent guidelines have stated that surgical therapy is generally indicated. This study sought to utilize the International Registry of Acute Aortic Dissection to investigate trends over time in the management of this condition. Methods: Of 3503 Type A patients enrolled in the International Registry of Acute Aortic Dissection, 141 (4.0%) were identified as having an IMH. This cohort was stratified by date of presentation into three time periods of equal length: Group 1, 1996-2003 (N=28, 19.9%); Group 2, 2004-2009 (N=30, 21.3%); and Group 3, 2010-2015 (N=83, 58.9%). Results: The study population was 47.5% female with an average age of 70.6 years. Surgery was performed in 71.4% of IMH patients in Group 1, increasing to 81.9% in Group 3 (p=0.492, trend p=0.261), which was not statistically significant. Reasons for receiving medical versus surgical management included advanced age (N=8, 47.1%), comorbid illness (N=12, 57.1%), and patient refusal (N=3, 23.1%). IMH of the arch was identified as a reason for medical management in 6 patients (47.1%). There was no difference in time to diagnosis between groups, with medians of 3.0 hours in Group 1 to 2.6 hours in Group 3 (p=0.971). Notably, surgical mortality decreased between 1996 to 2015, from 35.0% in Group 1 to 13.2% in Group 3 (p=0.087, trend p=0.030). Conclusions: Operative mortality for Type A IMH decreased over time, providing further support for surgical repair in these patients. In the absence of personalized risk models for surgical and medical outcomes utilizing imaging and genomic data, surgical management appears to be the optimal therapy for acute Type A IMH.
Background: In March 2010, the American Heart Association (AHA), American College of Cardiology (ACC), and other societies released new guidelines for the diagnosis and management of patients with ...
Little is known about the relationship between patient satisfaction with inpatient care and post-discharge outcomes. This study examined inpatient hospital satisfaction after a cardiac event and outcomes through 6 months post-discharge. We examined 327 cardiac patients from the Bridging the Discharge Gap Effectively database who completed a patient satisfaction survey about their hospital admission and had post-discharge outcomes data. Higher patient satisfaction with the discharge process correlated with fewer readmissions at 90 days post-discharge. Higher patient satisfaction with hospital staff management of personal issues correlated with fewer emergency department visits at 6 months post-discharge. Higher patient satisfaction with overall assessment of care and hospitalization correlated with lower mortality rate at 6 months post-discharge. Being nonwhite correlated with lower nursing care satisfaction. Associations between cardiac patient satisfaction and outcomes exist. In this population, higher patient satisfaction correlated with better outcomes. Patient satisfaction data may be able to inform areas for health system improvement.
