Demographic and Regional Trends of Mortality in Patients With Aortic Dissection in the United States, 1999 to 2019

Nazir, Salik; Ariss, Robert W.; Minhas, Abdul Mannan Khan; Issa, Rochell; Michos, Erin D.; Birnbaum, Yochai; Moukarbel, George V.; Ramanathan, P. Kasi; Jneid, Hani

doi:10.1161/jaha.121.024533

Cited by 9 publications

(5 citation statements)

References 39 publications

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“…The CDC WONDER database has been utilized to study trends of mortality in various disease states. 13 , 14 Informed consent was not applicable as the data are deidentified and public. This study was exempt from local institutional review board approval because the CDC WONDER database includes only deidentified publicly available data.…”

Section: Methodsmentioning

confidence: 99%

Trends in Infective Endocarditis Mortality in the United States: 1999 to 2020: A Cause for Alarm

Chobufo,

Atti,

Vasudevan

et al. 2023

JAHA

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Background Data on national trends in mortality due to infective endocarditis (IE) in the United States are limited. Methods and Results Utilizing the multiple causes of death data from the Centers for Disease Control and Prevention's Wide‐Ranging Online Data for Epidemiologic Research database from 1999 to 2020, IE and substance use were identified using the International Classification of Diseases, Tenth Revision, Clinical Modification codes. Between 1999 and 2020, the IE‐related age‐adjusted mortality rates declined. IE‐related crude mortality accelerated significantly in the age groups 25–34 years (average annual percentage change, 5.4 [95% CI, 3.1–7.7]; P <0.001) and 35–44 years (average annual percentage change, 2.3 [95% CI, 1.3–3.3]; P <0.001), but remained stagnant in those aged 45–54 years (average annual percentage change, 0.5 [95% CI, −1.9 to 3]; P =0.684), and showed a significant decline in those aged ≥55 years. A concomitant substance use disorder as multiple causes of death in those with IE increased drastically in the 25–44 years age group ( P <0.001). The states of Kentucky, Tennessee, and West Virginia showed an acceleration in age‐adjusted mortality rates in contrast to other states, where there was predominantly a decline or static trend for IE. Conclusions Age‐adjusted mortality rates due to IE in the overall population have declined. The marked acceleration in mortality in the 25‐ to 44‐year age group is a cause for alarm. Regional differences with acceleration in IE mortality rates were noted in Kentucky, Tennessee, and West Virginia. We speculate that this acceleration was likely due mainly to the opioid crisis that has engulfed several states and involved principally younger adults.

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Section: Methodsmentioning

confidence: 99%

Trends in Infective Endocarditis Mortality in the United States: 1999 to 2020: A Cause for Alarm

Chobufo,

Atti,

Vasudevan

et al. 2023

JAHA

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“…Thoracic aortic disease (TAD) causes over 2000 deaths per year in the UK and almost 10,000 in the US. (1, 2) The prevalence of the disease is increasing. (3) TAD has a long latent phase characterised by asymptomatic aneurysm formation followed by presentation with an acute aortic syndrome, most commonly an acute aortic dissection, which has >70% mortality.…”

Section: Introductionmentioning

confidence: 99%

Barriers to cascade screening in people at risk of Thoracic Aortic Disease: a mixed methods evaluation from the DECIDE-TAD initiative

Abbasciano,

Dionne,

Miksza

et al. 2023

Preprint

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BackgroundCascade genetic and imaging screening for relatives of people with non-syndromic thoracic aortic diseases (NS-TAD) is recommended by guidelines. However, the availability and uptake of cascade screening is low. The aim of this study was to use applied health research methods to identify barriers to screening, and strategies to overcome these.MethodsA cohort study using routinely collected health data evaluated barriers to imaging, genetic testing, and treatment for people with NS-TAD. Delphi consensus exercises and workshops evaluated the screening process and patient experience. Focus groups considered strategies to overcome individual and institutional barriers to uptake. A consensus exercise evaluated the evidence to support cascade screening.ResultsA cohort study of 33,793 patients with a TAD diagnosis between 2013 and 2018 demonstrated barriers to treatment and imaging surveillance in females, non-whites, and people from-low socioeconomic backgrounds. A survey of aortic dissection survivors and relatives in England reported that 33/70 (47%) of aortic dissection survivors who responded had undergone genetic testing, including 10/22 (45%) with a positive family history of TAD. In first- and second-degree relatives 66/150 (44%) and 32/155 (21%) of respondents were offered imaging or cascade genetic testing respectively. Only 19/70 (27%) probands and 20/155 (13%) relatives who responded reported that they were involved in shared decisions about their care. Barriers to the uptake of cascade screening included limited awareness of the disease and genetic aetiology, poor health literacy, concerns about cost-effectiveness of screening with low detection rates, requirements for life-long surveillance, and the management of uncertain test results. The consensus exercise demonstrated that the certainty of the evidence to guide cascade screening was Low or Very Low.ConclusionsBarriers to the implementation of cascade screening in people at high-risk for TAD occur at multiple levels suggesting that a complex intervention is required to improve equity of access.

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“… 10–13 , 15 , 16 An exact number of patients who could benefit from post-dissection CR is not known, but recent data suggest that the incidence of SCAD may be higher than previously estimated, and there are no signs suggesting that the incidence of AD has lessened since early reports of the 1980s ( Table 1 ). 2 , 24–29 …”

Section: Introductionmentioning

confidence: 99%

“… c Overall age-adjusted mortality rate in 2019 (Nazir et al . 24 ). +Unlikely causative associations.…”

Section: Introductionmentioning

confidence: 99%

Individualized exercise prescription and cardiac rehabilitation following a spontaneous coronary artery dissection or aortic dissection

Iterson

Laffin

Svensson

et al. 2022

European Heart Journal Open

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Importance Prescribed aerobic-based exercise training is a low risk fundamental component of cardiac rehabilitation (CR). Secondary prevention therapeutic strategies following a spontaneous coronary artery dissection (SCAD) or aortic dissection (AD) should include CR. Current exercise guidance for post-dissection patients recommends fundamental training components including target heart rate zones are not warranted. Omitting fundamental elements from exercise prescriptions risks safety and makes it challenging for both clinicians and patients to understand and implement recommendations in real-world practice. We review the principles of exercise prescription for CR, focusing on translating guidelines and evidence from well-studied high-risk CR populations to support the recommendation that exercise testing and individualized exercise prescription are important for patients following a dissection. Discussion When patients self-perceive exercise intensity there is a tendency to underestimate intensities within metabolic domains that should be strictly avoided during routine exercise training following a dissection. However, exercise testing associated with CR enrollment has gained support and not been linked to adverse events in optimally medicated post-dissection patients. Graded heart rate and blood pressure responses recorded throughout exercise testing provide key information for developing an exercise prescription. An exercise prescription that is reflective of medical history, medications, and cardiorespiratory fitness optimizes patient safety and yields improvements in blood pressure control and cardiorespiratory fitness, among other benefits. Conclusion This clinical practice and education article demonstrates how to develop and manage a CR exercise prescription for post-acute dissection patients that can be safe and effective for maintaining blood pressure control and improving cardiorespiratory fitness pre-post CR.

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Demographic and Regional Trends of Mortality in Patients With Aortic Dissection in the United States, 1999 to 2019

Cited by 9 publications

References 39 publications

Trends in Infective Endocarditis Mortality in the United States: 1999 to 2020: A Cause for Alarm

Trends in Infective Endocarditis Mortality in the United States: 1999 to 2020: A Cause for Alarm

Barriers to cascade screening in people at risk of Thoracic Aortic Disease: a mixed methods evaluation from the DECIDE-TAD initiative

Individualized exercise prescription and cardiac rehabilitation following a spontaneous coronary artery dissection or aortic dissection

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