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

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. The Inpatient Medicare data from 2000 to 2011 were used to determine tre...

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Veröffentlicht in:Circulation Cardiovascular quality and outcomes Jg. 7; H. 6; S. 920
Hauptverfasser: Mody, Purav S, Wang, Yun, Geirsson, Arnar, Kim, Nancy, Desai, Mayur M, Gupta, Aakriti, Dodson, John A, Krumholz, Harlan M
Format: Journal Article
Sprache:Englisch
Veröffentlicht: United States 01.11.2014
Schlagworte:
Aged
Aged, 80 and over
Aortic Dissection - economics
Aortic Dissection - epidemiology
Aortic Dissection - therapy
Cost of Illness
Female
Hospital Mortality - trends
Hospitalization - economics
Hospitalization - trends
Humans
Inpatients
Length of Stay - economics
Male
Medicare - economics
Retrospective Studies
Survival Rate - trends
Treatment Outcome
United States - epidemiology
Vascular Surgical Procedures - economics
United States
mortality
epidemiology
aortic dissection
surgery
ISSN:1941-7705, 1941-7705
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Zusammenfassung: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. 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. Although AD hospitalization rates remained stable, improvement in mortality was noted, particularly in patients undergoing surgical repair.
Bibliographie:ObjectType-Article-1
SourceType-Scholarly Journals-1
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ISSN:1941-7705
1941-7705
DOI:10.1161/CIRCOUTCOMES.114.001140