Analisi “real-world” sulla popolazione italiana con ricovero urgente per dissezione aortica acuta di tipo A

BACKGROUND: Acute type A aortic dissection (AADA) is a life-threatening cardiovascular emergency whose prognosis is closely linked to the timeliness of diagnosis and treatment. However, its low incidence and highly variable clinical presentation make early recognition challenging. In addition, poor therapeutic adherence and inadequate surveillance of predisposing factors, including hypertension and aortic aneurysm, contribute to diagnostic delays and worse clinical outcomes. METHODS: A retrospective observational analysis was conducted using real-world administrative data from Italian healthcare facilities covering over 12 million individuals (2010-2024). Adult patients urgently hospitalized for AADA (ICD-9-CM 441.01) were identified. Clinical profile, comorbidities, pharmacological treatments, diagnostic procedures, and the presence of hypertension - defined as the number of annual prescriptions ≥ 9 (a proxy for diagnosis) of antihypertensive drugs - were evaluated. RESULTS: A total of 1625 patients were included (mean age 67.3 ± 13.4 years; 65.6% male). Diabetes was reported in 8.5% of cases, cardiovascular disease in 21.2%, and ascending aortic aneurysm or ectasia in 6%. In the year preceding hospitalization, 65.8% of patients had at least one antihypertensive prescription, but only 35% showed evidence of continuous treatment. Diagnostic procedures were infrequent: echocardiography was performed in 12.3% of patients, cardiac computed tomography/magnetic resonance angiography in 1.8%, and 24-h ambulatory blood pressure monitoring in 2.4%. CONCLUSIONS: This real-world analysis highlights major gaps in the pre-hospital management of AADA in Italy, characterized by suboptimal blood pressure control, poor therapeutic adherence, and limited use of diagnostic imaging in at-risk patients. These findings underscore the need for structured prevention and surveillance strategies aimed at the early recognition of predisposing conditions and the optimization of integrated care for patients at risk of acute aortic dissection.