Using the Southern Alberta Vasculitis Registry to Assess Quality of Care Standards for Giant Cell Arteritis

Objectives Using the Southern Alberta Vasculitis Registry, review quality of care metrics for giant cell arteritis (GCA). Methods The SAVR was searched for GCA cases. All cases met ACR classification criteria for GCA to improve comparability with other studies.[1] Living and deceased patients were included. The audit standards recommended by the UK GCA Hospital Quality standards (GHOST) were reviewed and included: Time to ultrasound, time to temporal biopsy, time to and PET/CT following request.[2] These audit standards were in keeping with the recommendations noted in the ACR/VF 2021 GCA treatment guidelines.[3] Results Figure 1 shows full breakdown. High-dose steroids: The GHOST benchmark is administration of high-dose steroid within 24 hrs. The SAVR median (1 day) met this standard but not the mean (2.91 days, range 1-16 days). 88% of patients received high-dose steroids. Of these, 11% (5/45) received methylprednisolone. All cases of methylprednisolone use involved patients with vision loss or stroke features. Patients who did not receive high-dose steroids either had lower dose steroid started by non-rheumatologist (2/45) or had an incidental discovery of their GCA and were on alternative therapies (3/45). Time to temporal artery biopsy (TAB): The median (4 days) and mean (15.04 days) both meet the GHOST benchmark (28 days). The mean did not meet the ACR/EULAR recommendations of TAB within 14 days. 51% of patients received TAB, 74% of those had a positive TAB. Time to temporal artery ultrasound (TAUS): The median (6 days) but not the mean (16.75 days) met the GHOST benchmark (7 days). 36% of patients receive TAUS and 75% of those had a positive TAUS. Time to PET/CT: Neither the median (38 days) nor the mean (37 days) met the GHOST benchmark (7 days). Only 8.9% (4//45) patients had PET/CT imaging as part of their baseline imaging for GCA. Figure 1 Conclusion This study highlights the importance of establishing local clinical care pathways for GCA diagnosis and management. While the GHOST benchmarks provide useful context, some of the standards are not readily applicable due to resource limitations in some jurisdictions (ex. PET/CT within 7 days of diagnosis). A further limitation of the GHOST recommendations are using time to intervention from steroid initiation rather than time to intervention from GCA diagnosis. Local concerns, not captured by GHOST benchmarks include high variable time to diagnosis (average 80.17 days, median 42 days, range 1-375 days) and low baseline large vessel imagine (CTA-8.8%, MRA-6.7%). [1.] Ponte C. Arthritis & Rheumatology 2022;74(12):1881-9. [2.] Bilton EJ. Eye (Lond) 2024;38(1):1-3. [3.] Maz M. Arthritis & Rheumatology 2021;73(8):1349-65. Practice Reflection Award

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