Trends in Aortic Dissection Hospitalizations, Interventions, and Outcomes Among Medicare Beneficiaries in the United States, 2000-2011

被引:69
作者
Mody, Purav S. [1 ]
Wang, Yun [2 ,3 ]
Geirsson, Arnar [4 ]
Kim, Nancy [2 ,5 ]
Desai, Mayur M. [2 ,6 ]
Gupta, Aakriti [9 ]
Dodson, John A. [10 ]
Krumholz, Harlan M. [2 ,7 ,8 ,11 ]
机构
[1] Univ Texas SW Med Ctr Dallas, Dept Internal Med, Dallas, TX 75390 USA
[2] Yale New Haven Med Ctr, Ctr Outcomes Res & Evaluat, New Haven, CT 06504 USA
[3] Harvard Univ, Sch Publ Hlth, Dept Biostat, Boston, MA 02115 USA
[4] Yale Univ, Sch Med, Dept Surg, Sect Cardiac Surg, New Haven, CT 06510 USA
[5] Yale Univ, Sch Med, Dept Internal Med, Gen Internal Med Sect, New Haven, CT 06510 USA
[6] Yale Univ, Dept Chron Dis Epidemiol, Sch Publ Hlth, New Haven, CT USA
[7] Yale Univ, Sch Med, Dept Internal Med, Robert Wood Johnson Clin Scholars Program, New Haven, CT 06510 USA
[8] Yale Univ, Sch Med, Dept Internal Med, Sect Cardiovasc Med, New Haven, CT 06510 USA
[9] Yale Univ, Sch Med, Dept Internal Med, New Haven, CT 06510 USA
[10] NYU, Sch Med, Cardiol Sect, Dept Internal Med, New York, NY USA
[11] Yale Univ, Sch Publ Hlth, Dept Hlth Policy & Management, New Haven, CT USA
来源
CIRCULATION-CARDIOVASCULAR QUALITY AND OUTCOMES | 2014年 / 7卷 / 06期
关键词
aortic dissection; epidemiology; mortality; surgery; 30-DAY MORTALITY-RATES; INTERNATIONAL REGISTRY; AXILLARY ARTERY; RELATIVE RISK; A DISSECTION; ODDS RATIO; SURGERY; MANAGEMENT; ANEURYSM; REPAIR;
D O I
10.1161/CIRCOUTCOMES.114.001140
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
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.
引用
收藏
页码:920 / +
页数:20
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