Purav S Mody1, Yun Wang1, Arnar Geirsson1, Nancy Kim1, Mayur M Desai1, Aakriti Gupta1, John A Dodson1, Harlan M Krumholz2. 1. From the Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX (P.S.M.); Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT (Y.W., N.K., M.M.D., H.M.K.); Department of Biostatistics, Harvard School of Public Health, Boston, MA (Y.W.); Section of Cardiac Surgery, Department of Surgery, Yale University School of Medicine, New Haven, CT (A. Geirsson); Section of General Internal Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT (N.K.); Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT (M.M.D.); Robert Wood Johnson Clinical Scholars Program, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT (H.M.K.); Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT (H.M.K.); Department of Internal Medicine, Yale University School of Medicine, New Haven, CT (A. Gupta) Section of Cardiology, Department of Internal Medicine, New York University School of Medicine, New York, NY (J.A.D.); and Department of Health Policy and Management, Yale School of Public Health, New Haven, CT (H.M.K.). 2. From the Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX (P.S.M.); Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT (Y.W., N.K., M.M.D., H.M.K.); Department of Biostatistics, Harvard School of Public Health, Boston, MA (Y.W.); Section of Cardiac Surgery, Department of Surgery, Yale University School of Medicine, New Haven, CT (A. Geirsson); Section of General Internal Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT (N.K.); Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT (M.M.D.); Robert Wood Johnson Clinical Scholars Program, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT (H.M.K.); Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT (H.M.K.); Department of Internal Medicine, Yale University School of Medicine, New Haven, CT (A. Gupta) Section of Cardiology, Department of Internal Medicine, New York University School of Medicine, New York, NY (J.A.D.); and Department of Health Policy and Management, Yale School of Public Health, New Haven, CT (H.M.K.). harlan.krumholz@yale.edu.
Abstract
BACKGROUND: The epidemiology of aortic dissection (AD) has not been well described among older persons in the United States. It is not known whether advancements in AD care over the last decade have been accompanied by changes in outcomes. METHODS AND RESULTS: The Inpatient Medicare data from 2000 to 2011 were used to determine trends in hospitalization rates for AD. Mortality rates were ascertained through corresponding vital status files. A total of 32 057 initial AD hospitalizations were identified. The overall hospitalization rate for AD remained unchanged at 10 per 100 000 person-years. For 30-day and 1-year mortality associated with AD, the observed rate decreased from 31.8% to 25.4% (difference, 6.4%; 95% confidence interval [CI], 6.2-6.5; adjusted, 6.4%; 95% CI, 5.7-6.9) and from 42.6% to 37.4% (difference, 5.2%; 95% CI, 5.1-5.2; adjusted, 6.2%; 95% CI, 5.3-6.7), respectively. For patients undergoing surgical repair for type A dissections, the observed 30-day mortality decreased from 30.7% to 21.4% (difference, 9.3%; 95% CI, 8.3-10.2; adjusted, 7.3%; 95% CI, 5.8-7.8) and the observed 1-year mortality decreased from 39.9% to 31.6% (difference, 8.3%; 95% CI, 7.5-9.1%; adjusted, 8.2%; 95% CI, 6.7-9.1). The 30-day mortality decreased from 24.9% to 21% (difference, 3.9%; 95% CI, 3.5-4.2; adjusted, 2.9%; 95% CI, 0.7-4.4) and 1-year decreased from 36.4% to 32.5% (difference, 3.9%; 95% CI, 3.3-4.3; adjusted, 3.9%; 95% CI, 2.5-6.3) for surgical repair of type B dissection. CONCLUSIONS: Although AD hospitalization rates remained stable, improvement in mortality was noted, particularly in patients undergoing surgical repair.
BACKGROUND: The epidemiology of aortic dissection (AD) has not been well described among older persons in the United States. It is not known whether advancements in AD care over the last decade have been accompanied by changes in outcomes. METHODS AND RESULTS: The Inpatient Medicare data from 2000 to 2011 were used to determine trends in hospitalization rates for AD. Mortality rates were ascertained through corresponding vital status files. A total of 32 057 initial AD hospitalizations were identified. The overall hospitalization rate for AD remained unchanged at 10 per 100 000 person-years. For 30-day and 1-year mortality associated with AD, the observed rate decreased from 31.8% to 25.4% (difference, 6.4%; 95% confidence interval [CI], 6.2-6.5; adjusted, 6.4%; 95% CI, 5.7-6.9) and from 42.6% to 37.4% (difference, 5.2%; 95% CI, 5.1-5.2; adjusted, 6.2%; 95% CI, 5.3-6.7), respectively. For patients undergoing surgical repair for type A dissections, the observed 30-day mortality decreased from 30.7% to 21.4% (difference, 9.3%; 95% CI, 8.3-10.2; adjusted, 7.3%; 95% CI, 5.8-7.8) and the observed 1-year mortality decreased from 39.9% to 31.6% (difference, 8.3%; 95% CI, 7.5-9.1%; adjusted, 8.2%; 95% CI, 6.7-9.1). The 30-day mortality decreased from 24.9% to 21% (difference, 3.9%; 95% CI, 3.5-4.2; adjusted, 2.9%; 95% CI, 0.7-4.4) and 1-year decreased from 36.4% to 32.5% (difference, 3.9%; 95% CI, 3.3-4.3; adjusted, 3.9%; 95% CI, 2.5-6.3) for surgical repair of type B dissection. CONCLUSIONS: Although AD hospitalization rates remained stable, improvement in mortality was noted, particularly in patients undergoing surgical repair.
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