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Performance of a fast-track pathway for giant cell arteritis in Waikato, Aotearoa New Zealand
Philippa van Dantzig1, Douglas White2, Jason Kurz3
1Rheumatology Department, Te Whatu Ora, Waikato Hospital, Hamilton, New Zealand.
Insights
Giant cell arteritis (GCA) diagnosis is improved by fast-track pathways. This pathway reduces corticosteroid use and unnecessary temporal artery biopsies in patients over 50.
Area of Science:
- Rheumatology
- Vascular Medicine
- Diagnostic Imaging
Background:
- Giant cell arteritis (GCA) is the most prevalent primary vasculitis affecting individuals over 50.
- Fast-track pathways are implemented to expedite GCA diagnosis and mitigate risks associated with prolonged corticosteroid therapy and invasive temporal artery biopsies.
Purpose of the Study:
- To evaluate the efficacy and benefits of a fast-track pathway for diagnosing GCA in Aotearoa, New Zealand.
- To assess the impact of the pathway on patient outcomes, including corticosteroid exposure and the need for biopsies.
Main Methods:
- A retrospective review of prospectively collected patient data from a fast-track pathway (2014-2022).
- Analysis of clinical features, investigations (specifically color Doppler ultrasound - CDUS), and treatment outcomes.
- Comparison of outcomes between patients with and without GCA diagnosis.
Main Results:
- Out of 648 patients undergoing temporal artery CDUS, 17 were true positives, yielding a sensitivity of 10.3% and specificity of 99.8%.
- Patients with GCA and positive CDUS received significantly less steroid treatment compared to those with GCA and negative scans (p=0.0037).
- 376 patients were discharged without a GCA diagnosis, avoiding unnecessary corticosteroid and biopsy procedures.
Conclusions:
- The study confirms the real-world benefits of fast-track pathways for GCA diagnosis in Aotearoa, New Zealand, positively impacting both patients and healthcare systems.
- The findings highlight the influence of corticosteroid use on CDUS results, a crucial factor for optimizing fast-track pathway implementation.
Aims:
Giant cell arteritis (GCA) is the most common primary vasculitis in adults over 50 years of age. To facilitate early diagnosis and reduce harms from corticosteroids and temporal artery biopsies, fast-track pathways have been established. We review the benefits of the fast-track pathway set up in Waikato, Aotearoa New Zealand.
Methods:
Patients were collected prospectively as part of the fast-track pathway from 2014 to 2022. Their records were then reviewed retrospectively to collect data on clinical features, investigations and treatment.
Results:
There were 648 individual patients over the study period who had a colour Doppler ultrasound (CDUS) of the temporal arteries. There were 17 true positive CDUS, giving a sensitivity of 10.3% (95% confidence interval [CI] 6.3-15.5%) and specificity of 99.8% (95% CI 99.1-100%). Patients with GCA and a positive scan had significantly fewer steroids than those with GCA and a negative scan (p=0.0037). There were 376 patients discharged after a CDUS who did not have a diagnosis of GCA, resulting in reduced corticosteroid and temporal artery biopsy exposure.
Conclusions:
This is a real-life study that reflects the benefits of fast-track pathways in Aotearoa New Zealand to patients and healthcare systems. It also shows the effect of corticosteroids on positive CDUS, an important consideration when setting up an fast-track pathway.
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