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Fast track pathway reduces sight loss in giant cell arteritis: results of a longitudinal observational cohort study

1, 2, 3, 4, 5, 6, 7, 8, 9

 

  1. Southend University Hospital, Essex, UK; and Aditya Birla Memorial Hospital, Pune, India.
  2. Southend University Hospital, Essex, UK.
  3. Southend University Hospital, Essex, UK.
  4. Southend University Hospital, Essex, UK.
  5. Southend University Hospital, Essex, UK.
  6. Southend University Hospital, Essex, UK, and Medical University Graz, Austria.
  7. Southend University Hospital, Essex, UK.
  8. Castle Point and Rochford Clinical Commissioning Group, Essex, UK.
  9. Southend University Hospital, Essex, UK.

CER8293
2015 Vol.33, N°2 ,Suppl.89
PI 0103, PF 0106
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PMID: 26016758 [PubMed]

Received: 16/01/2015
Accepted : 27/03/2015
In Press: 26/05/2015
Published: 26/05/2015

Abstract

OBJECTIVES:
To investigate the effectiveness of a fast track pathway (FTP) on sight loss in patients with suspected giant cell arteritis (GCA).
METHODS:
A longitudinal observational cohort study was conducted in the secondary care rheumatology department. One hundred and thirty-five newly referred suspected GCA patients seen via the FTP (Jan. 2012-Dec. 2013) were compared to 81 patients seen through the conventional referral and review system (Jan. 2009-Dec. 2011).
RESULTS:
The FTP resulted in significant reduction in irreversible sight loss from 37.0% (as seen in the historical cohort 2009-2011) to 9.0 % (2012-2013, OR 0.17, p=0.001). Adjustment for clinical and demographic parameters including known risk factors for GCA associated blindness did not significantly change the primary result (OR 0.08, p=0.001). FTP resulted in a reduction of time from symptom onset to diagnosis, particularly by reduction of time from general practitioner’s (GP) referral to the rheumatology review (79% of FTP patients were seen within one working day compared to 64.6 % in the conventional pathway, p=0.023). The FTP has seen a reduction in number of GP appointments.
CONCLUSIONS:
There was a significant reduction of permanent sight loss with a fast track GCA pathway. The effect may be due to multiple factors including better GP education and reduction in delayed diagnosis. These results need verification at other sites.

Rheumatology Article