Aortic Dissection

Case for Change
Toolkit

 
 
 


  

Case for Change

Aortic dissection is the 15th leading cause of death in the United States, and annual deaths are estimated at 5,000 to 10,000. Because aortic dissection symptoms may often mimic heart attack, flu, severe muscle pain or other medical conditions the diagnosis is easily missed. About 20% of aortic aneurysms and dissections are genetically based and for these patients, problems can occur at any age. A common misconception is that aortic problems occur only in older people, typically males over age 50; therefore the likelihood of aortic disease in seemingly healthy young people is underestimated. Additionally, aortic dissection is the leading cause of death for patients with Marfan syndrome. Their risk for aortic dissection is 250 times greater than the general population.

Dissection of the ascending aorta is a surgical emergency. Approximately 35% of patients with dissection will die within the first 24 hours and 80% within the first 2 weeks of presentation. Although there is a 2% increase in mortality for every hour delay in treatment, surgical mortality is as low as 5-10% if intervention occurs early.

Emergency physicians are in a position to reduce mortality due to aortic dissection by taking a family history of all individuals who present with chest pain. The Iowa Healthcare Collaborative has developed this toolkit to equip Iowa physicians in screening, identifying and treating individuals with aortic dissection.

This toolkit will:

  • Increase provider awareness and education of aortic dissection
  • Provide a tool to assess familial risk for aortic dissection

Sources:

  • "Nonsyndromic Genetic Predisposition to Aortic Dissection." Sumera N. Hasham et al. Annals of Emergency Medicine' January 2004. 43:1
  • Mayo Clinic. http://www.mayoclinic.com/health/aortic-dissection/DS00605
  • "Aortic Dissection at Any Age: The Tyler Kahle Story." Sarah Juster. Presentation at ASHRM Annual Conference, 2008 "Aortic Dissection at Any Age". Julie Cerney. Nebraska Methodist Hospital Health Connections. 2007

 

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Toolkit

 Evidence Based Clinical Guidelines

Guidelines for the treatment of thoracic aortic disease are to be published in Circulation in 2010. They will be added to this website when available.


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Forms

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Educational Materials

Provider Education

  • New England Journal of Medicine
    This link provides access to the abstract of a study assessing the safety and reliabiility of noninvasive imaging methods in diagnosing aortic dissection. At the bottom of the abstract is a  link to the full text article.

Patient Education

  • American Heart Association
    This article provides patient information on diagnosis, treatment, and genetic conditions associated with aortic dissection.
     
  • American Heart Association
    This link provides an overview of aortic dissection including symptoms and predisposing factors.
     
  • AorticDissection.com
    The purpose of this website is to provide other aortic dissection patients with a single source of information.
     
  • National Marfan Foundation
    This website provides extensive information on Marfan Syndrome, including causes, characteristics, diagnosis and treatment options.
     

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Success Stories

Nebraska Methodist Health System
19 year-old Tyler Kahle died Oct. 7, 2002 of an undetected aortic dissection after two visits to Nebraska Methodist Hospital's emergency room with the diagnosis of pleurisy. X-rays and EKGs ruled out the possibility of heart attack; however neither test can reveal problems with the aorta. Because of Tyler's young age, assumptions were made that aortic dissection was unlikely. Tyler's father was 42 when he suffered an aortic dissection and Tyler's uncle died of an aortic dissection at age 38.

As a result of Tyler's death, a major quality initiative was launched at Methodist Hospital to educate physicians. New emergency department protocols were put in place, including a customized intake form that physicians use in diagnosing chest pain patients. Regardless of the patient's age, physicians are prompted to verify both a personal and family history of aortic aneurysm and dissection, take those answers into consideration and order specific imaging studies if they cannot exclude aortic disease as a cause of the pain.

With the new protocols and the development of a Chest Pain Center located in the hospital's emergency department, more patients with aortic dissection are identified and more lives are saved.

An educational video was created to support awareness about aortic dissection and is part of a continuing education program for medical professionals. To view "Aortic Dissection at Any Age; The Tyler Kahle Story" online, visit www.bestcare.org/Tyler.
 

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Mentors

This tool kit was developed in collaboration with the Nebraska Methodist Health System. IHC would like to thank those individuals and organizations who have shared their materials and who have agreed to serve as mentors. Please contact IHC if your organization would like to contribute materials to this tool kit.

  • Nebraska Methodist Health System
    Contact: Anton F. Piskac, M.D.
    Email: apiskac@nmhs.org

 

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Resources

 

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