Abstract 4359697: Changes in Management of Acute Aortic Syndrome with Vascular Medicine Involvement in a Multidisciplinary Aortic Team

Abstract

Background: Recent AHA and ESC guidelines endorse multidisciplinary management of acute aortic syndromes (AAS), but the impact of including non-surgical cardiovascular specialists remains unexplored. In 2016, Beth Israel Deaconess Medical Center launched a multidisciplinary aortic center that includes vascular medicine (VM) consultation at the discretion of surgical teams. Objective: To evaluate inpatient and post-discharge outcomes associated with VM consultation in patients with AAS. Methods: We conducted a single-center retrospective study of 364 patients admitted with AAS between October 2010 and December 2023. Patients were stratified by VM consultation: VM+ (n=195) vs. VM− (n=169). Clinical characteristics, inpatient outcomes, discharge metrics, and follow-up data were compared between groups. Results: VM+ patients were slightly older (68.0±15.3 vs. 65.6±14.1 years), more often female (47.2% vs. 42.0%), and had more former/current smokers (58.5% vs. 49.7%). Dissection was more common in the VM− group (92.3% vs. 80.5%), while mixed-type and intramural hematomas were more frequent in the VM+ group. In-hospital survival was significantly higher in the VM+ group (96.4% vs. 87.6%, p =0.003), with consistently higher survival across subgroups and an independent association with greater odds of survival (adjusted OR 3.13, 95% CI 1.14–8.60, p =0.027). At discharge, VM+ patients had lower systolic blood pressure (114±14.8 vs. 120±18.5 mmHg, p =0.003), lower heart rate (68.8±12.1 vs. 74.9±11.6 bpm, p <0.001), and more antihypertensive agents (2.64±1.38 vs. 1.81±1.09, p <0.001). Beta-blocker (94.7% vs. 88.5%, p =0.044) and ACEi/ARB (55.9% vs. 28.4%, p <0.001) use was also more common in VM+ patients. Length of stay (12.7±20.1 vs. 11.4±10.2 days, p =0.449) and 90-day readmission (28.2% vs. 31.8%, p =0.548) were similar. Follow-up at 12 months was more frequent in VM+ patients for vascular medicine (62.2% vs. 29.7%, p <0.001) and imaging (72.9% vs. 61.5%, p =0.034), while vascular surgery follow-up was more common in the VM− group (77.7% vs. 67.0%, p =0.038). Genetic evaluation within 24 months was also more frequent in VM+ patients (12.2% vs. 2.0%, p <0.001). Conclusions: VM consultation in a multidisciplinary aortic team was associated with improved in-hospital survival, more intensive discharge medication management, and greater longitudinal follow-up. These findings support integrating VM specialists into team-based care for AAS.