Clinical Scorecard: Trends and Disparities in Mortality Related to Aortic Aneurysm and Aortic Dissection in the United States (1999-2023): An Analysis Using the CDC WONDER Database

At a Glance

Key Highlights

• AA classified into thoracic (TAA) and abdominal (AAA) subtypes; AD classified by Stanford types A and B with differing prognosis and management
• AA mortality in the US has declined overall, but TAA incidence has increased; AD incidence stable with reduced in-hospital mortality for type A
• Significant disparities in mortality exist by sex, race/ethnicity, age, geographic region, and urbanization status

Guideline-Based Recommendations

Diagnosis

• Use imaging modalities (e.g., chest imaging) for detection of TAA and AAA
• Classify AD by Stanford system to guide management

Management

• Conservative pharmacotherapy (β-blockers, statins) for low-risk unruptured AA (diameter <5 cm, asymptomatic)
• Open surgical repair for ruptured AA and acute type A AD requiring urgent intervention
• Endovascular aneurysm repair (EVAR) and thoracic endovascular aortic repair (TEVAR) favored for ruptured AA, elderly patients, and complicated type B AD
• Microsurgical clipping for complex aneurysms in selected younger patients
• Optimal medical therapy for uncomplicated type B AD

Monitoring & Follow-up

• Regular imaging surveillance for aneurysm size and progression
• Monitor blood pressure and cardiovascular risk factors to prevent AD and AA progression

Risks

• Hypertension, aging, smoking, atherosclerosis, obesity, and substance abuse increase risk
• Delayed diagnosis and inadequate treatment contribute to higher mortality, especially in developing regions and disadvantaged populations

Patient & Prescribing Data

Adults ≥ 25 years with AA or AD in the United States

Pharmacotherapy with β-blockers and statins reduces rupture risk in low-risk AA; surgical and endovascular interventions tailored by disease type and patient factors

Clinical Best Practices

• Early identification and risk stratification using imaging and clinical classification systems
• Tailor management strategies based on aneurysm size, rupture status, dissection type, and patient comorbidities
• Address disparities by improving healthcare access and targeted interventions in high-risk demographic groups
• Implement preventive measures including smoking cessation and hypertension control
• Utilize multidisciplinary approaches combining medical, surgical, and endovascular therapies

References

• CDC WONDER Database