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Mortality associated with aortic dissection improved in recent years

Mortality associated with aortic dissection improved in recent years
Mody PS. Circ Cardiovasc Qual Outcomes. 2014;doi:10.1161/CIRCOUTCOMES.114.001140.
October 21, 2014
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From 2000 to 2011, mortality rates improved for patients with aortic dissection while hospitalization rates remained stable during the same period.

Researchers analyzed Medicare data from 2000 to 2011 to determine trends in hospitalization, mortality and interventions for patients with aortic dissection. During that time, they documented 32,057 hospitalizations for aortic dissection among Medicare fee-for-service beneficiaries.

Comorbidities in patients hospitalized for aortic dissection that increased over time included hypertension (2000, 65%; 2011, 71.5%), diabetes (2000, 8.9%; 2011, 13.9%), dementia (2000, 3.8%; 2011, 7.3%), renal failure (2000, 3%; 2011, 9.2%), pneumonia (2000, 8.5%; 2011, 12.6%), respiratory failure (2000, 2.1%; 2011, 5.1%) and depression (2000, 3.3%; 2011, 6.5%).

“Prior literature demonstrates that the profile of patients with chronic [CV] conditions, such as [HF], has become sicker with significant increase in the age and proportion of chronic comorbidities over the last decade,” Purav S. Mody, MD, from the department of internal medicine, University of Texas Southwestern Medical Center, Dallas, and colleagues wrote. “Hence, the aforementioned temporal changes in comorbidities are most likely real vs. more intense coding practice patterns.”

Hospitalization rates stable

The rate of hospitalization for aortic dissection remained stable throughout the study period at 10 per 100,000 person-years. Rates were also stable for all age, race and sex subgroups, and remained highest for older, male and black adults.

In all patients, the observed rate of 30-day mortality decreased from 31.8% in 2000 to 25.4% in 2011 (difference, 6.4%; 95% CI, 6.2-6.5; difference after adjustment for age, sex, race and comorbidities, 6.4%; 95% CI, 5.7-6.9) and the observed rate of 1-year mortality decreased from 42.6% in 2000 to 37.4% in 2011 (difference, 5.2%; 95% CI, 5.1-5.2; adjusted difference, 6.2%; 95% CI, 5.3-6.7), according to the researchers.

Breakdown by intervention

Mortality rates for patient subgroups by intervention were as follows:

•Patients undergoing surgical repair for type A dissections: 2000 30-day mortality, 30.7%; 2011 30-day mortality, 21.4%; difference, 9.3%; 95% CI, 8.3-10.2; adjusted difference, 7.3%; 95% CI, 5.8-7.8; 2000 1-year mortality, 39.9%; 2011 1-year mortality, 31.6%; difference, 8.3%; 95% CI, 7.5-9.1; adjusted difference, 8.2%; 95% CI, 6.7-9.1.
•Patients undergoing surgical repair for type B dissections: 2000 30-day mortality, 24.9%; 2011 30-day mortality, 21%; difference, 3.9%; 95% CI, 3.5-4.2; adjusted difference, 2.9%; 95% CI, 0.7-4.4; 2000 1-year mortality, 36.4%; 2011 1-year mortality, 32.5%; difference, 3.9%; 95% CI, 3.3-4.3; adjusted difference, 3.9%; 95% CI, 2.5-6.3.
•Patients treated with medical management only: decline from 2000 to 2011 in 30-day mortality, 3.9%; 95% CI, 3.8-4.1; adjusted difference, 4.5%; 95% CI, 3.4-5.2; decline between 2000 and 2011 in 1-year mortality, 2.4%; 95% CI, 2.3-2.7; adjusted difference, 4%; 95% CI, 2.6-4.9.

•Patients undergoing thoracic endovascular aortic repair, which was introduced in 2005: 2005 30-day mortality, 9.5%; 2011 30-day mortality, 13.9%; P=.4; 2005 1-year mortality, 16.7%; 2011 30-day mortality, 25.8%; P=.3; the sample sizes were too small to calculate adjusted mortality rates.
Disclosure: The study was supported by the NHLBI.

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