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Schiele P, König AN, Meyer A, Falk V, Nienaber CA, Kurz SD. Modelling years of life lost due to acute type A aortic dissection in the German healthcare setting: a predictive study. BMJ Open 2024; 14:e078398. [PMID: 38925695 PMCID: PMC11202649 DOI: 10.1136/bmjopen-2023-078398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Accepted: 05/23/2024] [Indexed: 06/28/2024] Open
Abstract
OBJECTIVES This study aimed to develop a patient-centred approach to the burden of acute type A aortic dissection (ATAAD) through modelling. The main objective was to identify potential improvements in managing this life-threatening cardiovascular condition and to provide evidence-based recommendations to optimise outcomes. DESIGN We developed a predictive model along patient pathways to estimate the burden of ATAAD through the years of life lost (YLLs) metric. The model was created based on a systematic review of the literature and was parameterised using demographic data from the German healthcare environment. The model was designed to allow interactive simulation of different scenarios resulting from changes in key impact factors. SETTING The study was conducted using data from the German healthcare environment and results from the literature review. PARTICIPANTS The study included a comprehensive modelling of ATAAD cases in Germany but did not directly involve participants. INTERVENTIONS There were no specific interventions applied in this study based on the modelling design. PRIMARY AND SECONDARY OUTCOME MEASURES The single outcome measure was the estimation of YLL due to ATAAD in Germany. RESULTS Our model estimated 102 791 YLL per year for ATAAD in Germany, with 62 432 and 40 359 YLL for men and women, respectively. Modelling an improved care setting yielded 93 191 YLL or 9.3% less YLL compared with the current standard while a worst-case scenario resulted in 113 023 or 10.0% more YLL. The model is accessible at https://acuteaorticdissection.com/ to estimate custom scenarios. CONCLUSIONS Our study provides an evidence-based approach to estimating the burden of ATAAD and identifying potential improvements in the management of pathways. This approach can be used by healthcare decision-makers to inform policy changes aimed at optimising patient outcomes. By considering patient-centred approaches in any healthcare environment, the model has the potential to improve efficient care for patients suffering from ATAAD.
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Affiliation(s)
- Philipp Schiele
- Department of Statistics, Ludwig-Maximilians-Universität München, München, Germany
| | - Adriana N König
- Munich School of Management and Munich Center of Health Sciences, Ludwig-Maximilians-Universität München, München, Germany
| | - Alexander Meyer
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charité (DHZC), Berlin, Germany
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Volkmar Falk
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charité (DHZC), Berlin, Germany
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
- Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
| | - Christoph A Nienaber
- National Heart and Lung Institute, Imperial College London, London, UK
- Cardiology and Aortic Centre, The Royal Brompton & Harefield Hospitals as part of Guys' and St. Thomas' NHS Foundation Trust, London, UK
| | - Stephan D Kurz
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charité (DHZC), Berlin, Germany
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
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Greve* D, Werner* D, Stroux A, Möckel M, Falk V, Dominik Kurz S. Air Rescue of Patients With Acute Aortic Syndromes. DEUTSCHES ARZTEBLATT INTERNATIONAL 2023; 120:483-484. [PMID: 37661319 PMCID: PMC10487669 DOI: 10.3238/arztebl.m2023.0043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 11/09/2022] [Accepted: 02/09/2023] [Indexed: 09/05/2023]
Affiliation(s)
- Dustin Greve*
- *These authors are co-first authors
- Deutsches Herzzentrum der Charité – Medical Heart Center of Charité and German Heart Institute Berlin, Department of Cardiothoracic and Vascular Surgery, Berlin; Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Daniel Werner*
- *These authors are co-first authors
- ADAC Luftrettung gGmbH, Munich; Hospital of the Ludwig-Maximilians-University Munich (LMU), Department of Anesthesiology, Munich, Germany
| | - Andrea Stroux
- Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Biometry and Clinical Epidemiology, Berlin, Germany
| | - Martin Möckel
- Deutsches Herzzentrum der Charité – Medical Heart Center of Charité and German Heart Institute Berlin, Department of Cardiothoracic and Vascular Surgery, Berlin; Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Volkmar Falk
- Deutsches Herzzentrum der Charité – Medical Heart Center of Charité and German Heart Institute Berlin, Department of Cardiothoracic and Vascular Surgery, Berlin; Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
- Swiss Federal Institute of Technology, Department of Health Science and Technology, Zurich, Switzerland
| | - Stephan Dominik Kurz
- Deutsches Herzzentrum der Charité – Medical Heart Center of Charité and German Heart Institute Berlin, Department of Cardiothoracic and Vascular Surgery, Berlin; Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
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Wundram M, Falk V, Eulert-Grehn JJ, Herbst H, Thurau J, Leidel BA, Göncz E, Bauer W, Habazettl H, Kurz SD. Incidence of acute type A aortic dissection in emergency departments. Sci Rep 2020; 10:7434. [PMID: 32366917 PMCID: PMC7198509 DOI: 10.1038/s41598-020-64299-4] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 04/14/2020] [Indexed: 11/10/2022] Open
Abstract
Due to the symptoms, patients with acute type A aortic dissection are first seen by the ambulance service and diagnosed at the emergency department. How often an aortic dissection occurs in an emergency department per year has been studied. The incidence in the emergency department may be used as a quality marker of differential diagnostics of acute chest pain. A multi-institutional retrospective study with the municipal Berlin hospital chain Vivantes and its Department of Pathology and the Charité - University Medicine Berlin was performed. From the Berlin Hospital Society, the annual numbers of publicly insured emergency patients were obtained. Between 2006 and 2016, 631 aortic dissections were identified. The total number of patients treated in the emergency departments (n = 12,790,577) was used to calculate the “emergency department incidence.” The autopsy data from six clinics allowed an estimate on how many acute type A aortic dissections remained undetected. Across all Berlin hospitals, the emergency department incidence of acute type A aortic dissection was 5.24 cases in 100,000 patients per year. In tertiary referral hospitals and, particularly, in university hospitals the respective incidences were markedly higher (6.7 and 12.4, respectively). Based on the autopsy results, about 50% of the acute type A aortic dissection may remain undetected, which would double the reported incidences. Among different hospital types the emergency department incidences of acute type A aortic dissection vary between 5.93/100,000 and 24.92/100,000. Aortic dissection; Incidence; Emergency Department; Epidemiology
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Affiliation(s)
- Maximilian Wundram
- Deutsches Herzzentrum Berlin, Institute for Anaesthesiology, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Volkmar Falk
- Deutsches Herzzentrum Berlin, Department of Cardiothoracic and Vascular Surgery, Augustenburger Platz 1, 13353, Berlin, Germany.,Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Cardiovascular Surgery, Augustenburger Platz 1, 13353, Berlin, Germany.,DZHK (German Center for Cardiovascular Research), partner site Berlin, 13353, Berlin, Germany
| | - Jaime-Jürgen Eulert-Grehn
- Deutsches Herzzentrum Berlin, Department of Cardiothoracic and Vascular Surgery, Augustenburger Platz 1, 13353, Berlin, Germany.,DZHK (German Center for Cardiovascular Research), partner site Berlin, 13353, Berlin, Germany
| | - Hermann Herbst
- Vivantes Klinikum Neukölln, Department of Pathology, 13407, Berlin, Germany
| | - Jana Thurau
- Deutsches Herzzentrum Berlin, Institute for Anaesthesiology, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Bernd A Leidel
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Campus Benjamin Franklin, Department of Emergency Medicine, 12200, Berlin, Germany
| | - Eva Göncz
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Campus Virchow-Klinikum, Department of Emergency Medicine, 13353, Berlin, Germany
| | - Wolfgang Bauer
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Campus Benjamin Franklin, Department of Emergency Medicine, 12200, Berlin, Germany
| | - Helmut Habazettl
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Physiology, Charitéplatz 1, Berlin, 10117, Germany
| | - Stephan D Kurz
- Deutsches Herzzentrum Berlin, Institute for Anaesthesiology, Augustenburger Platz 1, 13353, Berlin, Germany. .,Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Cardiovascular Surgery, Augustenburger Platz 1, 13353, Berlin, Germany. .,Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Physiology, Charitéplatz 1, Berlin, 10117, Germany.
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