SynthesisJournal of the American Heart Association2017
Unwarranted Variation in the Quality of Care for Patients With Diseases of the Thoracic Aorta.
Synthesis in Journal of the American Heart Association, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 22 papers, 5 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
22 citing papers in PubMed, 5 syntheses or guidelines pooled it, 52 citations in OpenAlex.
- 2022 ACC/AHA guideline for the diagnosis and management of aortic disease: A report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines.The Journal of thoracic and cardiovascular surgery · 2023Guideline
- Guideline
- 2022 ACC/AHA Guideline for the Diagnosis and Management of Aortic Disease: A Report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines.Journal of the American College of Cardiology · 2022Guideline
- Systematic Review of Studies That Have Evaluated Screening Tests in Relatives of Patients Affected by Nonsyndromic Thoracic Aortic Disease.Journal of the American Heart Association · 2018Pooled it
- Innominate vs. Axillary Artery Cannulation in Aortic Surgery: a Systematic Review and Meta-Analysis.Brazilian journal of cardiovascular surgeryPooled it
- The Aorta Is One Organ; Our Response Is Not: A Global Case for Systems Redesign in Acute Aortic Syndromes.Journal of clinical medicine · 2026Review
- Co-produced evidence-based recommendations for cascade screening and secondary prevention in the relatives of people diagnosed with non-syndromic thoracic aortic disease.Frontiers in cardiovascular medicine · 2026Article
- Cultural Biases and Clinical Variation.Clinics and practice · 2025Article
- Current techniques of repair of aortic arch pathologies and the role of the aortic team.Indian journal of thoracic and cardiovascular surgery · 2024Review
- Implementation of large, multi-site hospital interventions: a realist evaluation of strategies for developing capability.BMC health services research · 2024Article
- Screening for the vulnerable aorta: targeting high-risk groups in the population.The British journal of cardiology · 2023Article
- Open extent IV thoracoabdominal aneurysm repair: 22-year experience of the Scottish National Service.The British journal of surgery · 2022Article
- Aneurysm growth, survival, and quality of life in untreated thoracic aortic aneurysms: the effective treatments for thoracic aortic aneurysms study.European heart journal · 2022Article
- A fatal masquerade in pneumonia: Ruptured thoracic aortic aneurysm.Clinical case reports · 2022Article
- Neuroprotective strategies in acute aortic dissection: an analysis of the UK National Adult Cardiac Surgical Audit.European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery · 2021Article
- Decade-long trends in surgery for acute Type A aortic dissection in England: A retrospective cohort study.The Lancet regional health. Europe · 2021Article
- Early experience of aortic surgery during the COVID-19 pandemic in the UK: A multicentre study.Journal of cardiac surgery · 2021Article
- Report of a Delphi exercise to inform the design of a research programme on screening for thoracic aortic disease.Trials · 2020Article
- Extra-corporeal membrane oxygenation in aortic surgery and dissection: A systematic review.World journal of critical care medicine · 2019Article
- Variation between hospitals in outcomes following cardiac surgery in the UK.Annals of the Royal College of Surgeons of England · 2019Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
12 authors at 7 institutions in 1 country.
Funding
Abstract
backgroundThoracic aortic disease has a high mortality. We sought to establish the contribution of unwarranted variation in care to regional differences in outcomes observed in patients with thoracic aortic disease in England. METHODS AND
resultsData from the Hospital Episode Statistics (HES) and the National Adult Cardiac Surgery Audit (NACSA) were extracted. A parallel systematic review/meta-analysis through December 2015, and structure and process questionnaire of English cardiac surgery units were also accomplished. Treatment and mortality rates were investigated. A total of 24 548 adult patients in the HES study, 8058 in the NACSA study, and 103 543 from a total of 33 studies in the systematic review were obtained. Treatment rates for thoracic aortic disease within 6 months of index admission ranged from 7.6% to 31.5% between English counties. Risk-adjusted 6-month mortality in untreated patients ranged from 19.4% to 36.3%. Regional variation persisted after adjustment for disease or patient factors. Regional cardiac units with higher case volumes treated more-complex patients and had significantly lower risk-adjusted mortality relative to low-volume units. The results of the systematic review indicated that the delivery of care by multidisciplinary teams in high-volume units resulted in better outcomes. The observational analyses and the online survey indicated that this is not how services are configured in most units in England.
conclusionsChanges in the organization of services that address unwarranted variation in the provision of care for patients with thoracic aortic disease in England may result in more-equitable access to treatment and improved outcomes.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.