Trends in aortic dissection hospitalizations, interventions, and outcomes among medicare beneficiaries in the United States, 2000-2011

Purav S. Mody, Yun Wang, Arnar Geirsson, Nancy Kim, Mayur M. Desai, Aakriti Gupta, John A. Dodson, Harlan M. Krumholz

Research output: Contribution to journalArticle

28 Citations (Scopus)

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 personyears. 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.

Original languageEnglish (US)
Pages (from-to)920-928
Number of pages9
JournalCirculation: Cardiovascular Quality and Outcomes
Volume7
Issue number6
DOIs
StatePublished - Nov 1 2014

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Medicare
Dissection
Hospitalization
Confidence Intervals
Mortality
Inpatients
Epidemiology

Keywords

  • Aortic dissection
  • Epidemiology
  • Mortality
  • Surgery

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Trends in aortic dissection hospitalizations, interventions, and outcomes among medicare beneficiaries in the United States, 2000-2011. / Mody, Purav S.; Wang, Yun; Geirsson, Arnar; Kim, Nancy; Desai, Mayur M.; Gupta, Aakriti; Dodson, John A.; Krumholz, Harlan M.

In: Circulation: Cardiovascular Quality and Outcomes, Vol. 7, No. 6, 01.11.2014, p. 920-928.

Research output: Contribution to journalArticle

Mody, Purav S. ; Wang, Yun ; Geirsson, Arnar ; Kim, Nancy ; Desai, Mayur M. ; Gupta, Aakriti ; Dodson, John A. ; Krumholz, Harlan M. / Trends in aortic dissection hospitalizations, interventions, and outcomes among medicare beneficiaries in the United States, 2000-2011. In: Circulation: Cardiovascular Quality and Outcomes. 2014 ; Vol. 7, No. 6. pp. 920-928.
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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 personyears. 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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AU - Mody, Purav S.

AU - Wang, Yun

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AU - Kim, Nancy

AU - Desai, Mayur M.

AU - Gupta, Aakriti

AU - Dodson, John A.

AU - Krumholz, Harlan M.

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N2 - 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 personyears. 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.

AB - 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 personyears. 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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