The launch of the Acute Aortic Dissection (AAD) Pathway in the East of England represents a major step forward in emergency care. Led by the East of England Cardiac Network, this national initiative is designed to improve how hospitals manage and refer AAD cases across the region. Delays in diagnosis or treatment of aortic dissection can have fatal consequences, making a well-structured pathway essential.
This event brought together emergency clinicians, vascular surgeons, radiologists, cardiologists, and critical care specialists, all committed to improving survival rates through better coordination and standardised processes. Discussions focused on common challenges, the role of imaging in diagnosis, and best practices for transferring patients between hospitals. The new pathway is expected to improve decision-making and reduce delays, ensuring patients receive the care they need as quickly as possible.
Recognising AD in Emergency Settings
One of the key themes of the event was the challenge of recognising AAD in the emergency department. Aortic dissection can be difficult to diagnose because its symptoms often resemble other conditions such as heart attacks or strokes. Patients often present with sudden, severe chest or back pain, but variations in symptoms can lead to misdiagnosis. Some experience pain in the abdomen or even no pain at all, making clinical suspicion crucial.
Emergency teams discussed strategies to improve early recognition. Standardised assessment tools and clearer referral pathways can help ensure that AAD is considered in patients with high-risk features, particularly those with known risk factors such as hypertension, connective tissue disorders, or a history of aortic disease.
The role of CT imaging was also a major focus. Delays in obtaining or interpreting scans can slow down decision-making, which is why improving access to urgent CT aortograms is a key part of the new pathway. Radiologists play a critical role in identifying dissections and ensuring images are shared quickly between hospitals when transfer is needed.
Challenges in Diagnosis and Transfers
The discussion highlighted several common challenges in the current system. Many district general hospitals (DGHs) lack on-site cardiac surgery, meaning that once AAD is diagnosed, rapid transfer to a specialist centre is essential. However, arranging these transfers can be complex, particularly when critical care support is required.
Some of the issues identified included:
- Variability in emergency department protocols, leading to inconsistent approaches to AAD diagnosis and referral.
- Delays in obtaining CT scans and transferring imaging between hospitals.
- Difficulties in arranging inter-hospital transport, especially for critically unstable patients who require intensive care support.
- Uncertainty about pre-transfer management, such as blood pressure control and pain relief.
The new pathway aims to address these challenges by standardising the referral process, imaging protocols, and transfer criteria. A structured approach to patient stabilisation and transport should help ensure that all hospitals in the region follow a clear and coordinated plan.
Learning from Patient Experiences
One of the most impactful sessions of the event was a case study on Type A aortic dissection, where a patient required emergency surgery. The case illustrated the importance of early recognition, timely imaging, and efficient coordination between hospitals. It also highlighted areas for improvement, including the need for clearer communication between referring and receiving hospitals, as well as better pre-transfer management of blood pressure and pain control.
By analysing real cases, clinicians can refine their approach and apply lessons learned to future emergencies. The discussion reinforced the need for regional collaboration and adherence to standard protocols to ensure better patient outcomes.
Implementing the New AAD Pathway
The introduction of the AAD NHS Toolkit provides a structured framework for managing acute cases. The key elements of this new approach include:
- Standardised imaging protocols, ensuring rapid access to CT aortograms and efficient image sharing.
- Defined referral and transfer pathways, reducing delays in getting patients to specialist surgical centres.
- Improved coordination between emergency teams, radiologists, and cardiac centres, ensuring a seamless process from diagnosis to treatment.
- A new on-call rota for AAD referrals will help ensure that specialist teams are available when needed.
The success of these pathways will depend on ongoing training and feedback from frontline teams. Regular audits and case reviews will help identify areas for further improvement, ensuring that the system continues to evolve based on real-world experience.
A Step Towards Better AD Care
The launch of these pathways is part of a broader effort to improve aortic dissection care across the UK. Similar initiatives have been introduced in other regions, including the South East, South West, North West, Wales, and the Isle of Man. By sharing knowledge and standardising best practices, healthcare teams can work together to reduce misdiagnosis, speed up treatment, and ultimately save more lives.
For clinicians, adopting these pathways means greater clarity and efficiency when managing AAD cases. For patients and their families, it represents a significant step forward in ensuring that this life-threatening condition is recognised and treated as quickly as possible.
The event is an important milestone, but work remains to be done. Continued collaboration, training, and refinement of the pathways will be essential in ensuring their long-term success. The commitment shown by the healthcare teams involved suggests that aortic dissection care in the East of England is on the right path towards lasting improvement.
