Explaining the Decrease in Mortality From Abdominal Aortic Aneurysm Rupture

Vascular Surgery Research Group, Imperial College, Charing Cross Campus, St Dunstan's Road, London W6 8RP, UK.
British Journal of Surgery (Impact Factor: 5.54). 05/2012; 99(5):637-45. DOI: 10.1002/bjs.8698
Source: PubMed


A steady rise in mortality from abdominal aortic aneurysm (AAA) was reported in the 1980s and 1990 s, although this is now declining rapidly. Reasons for the recent decline in mortality from AAA rupture are investigated here.
Routine statistics for mortality, hospital admissions and procedures in England and Wales were investigated. All data were age-standardized. Trends in smoking, hypertension and treatment for hypercholesterolaemia (statins), together with regression coefficients for mortality, were available from public sources for those aged at least 65 years. Deaths from ruptured AAA avoided in this age group were estimated by using the IMPACT equation: deaths avoided = (deaths in index year) × (risk factor decline) × β-coefficient.
From 1997, deaths from ruptured AAA have decreased sharply, almost twofold in men. Hospital admissions for elective AAA repair have increased modestly (from 40 to 45 per 100,000 population), attributable entirely to more procedures in those aged 75 years and over (P < 0.001). Admissions for ruptured AAA have declined from 18.6 to 13.5 per 100,000 population, across all ages, with the proportion offered and surviving emergency repair unchanged. From 1997, mortality from ruptured aneurysm in those aged at least 65 years has fallen from 65.9 to 44.6 per 100,000 population. An estimated 8-11 deaths per 100,000 population were avoided by a reduced prevalence of smoking and a similar number from an increase in the number of elective AAA repairs. Estimates for the effects of blood pressure and lipid control are uncertain.
The reduction in incidence of ruptured AAA since 1997 is attributable largely to changes in smoking prevalence and increases in elective AAA repair in those aged 75 years and over.

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    • "One study has reported incidental AAA's seen on ultrasound scan (USS) in up to 11.4 % of men aged 60 years or older [2]. Mortality rates from AAA are now decreasing which is thought to be due to an increase in elective repairs and decrease in smoking prevalence [3] [4]. Contrast enhanced computed tomography (CT) approaches 100% accuracy in detection of AAA [5]. "
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    ABSTRACT: We present the brief case and radiological image of an 80 years old man with an incidental finding of a large abdominal aortic aneurysm. The patients CT scan clearly demonstrates a characteristic “Yin yang sign” pattern. Although a novel radiological finding this sign can be useful in identifying a partially thrombosed aneurysm when assessing undifferentiated radiological masses.
    09/2014; 2:3-4. DOI:10.14205/2309-4427.2014.02.01.2
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    • "Predictors of long-term mortality included age, chronic pulmonary disease, renal disease, liver disease and metastatic solid tumour; after removal of the perioperative deaths, social deprivation index replaced strategic health authority as a predictor of long-term survival. These indicators represent potential areas for targeted improvement of the 5-year outcome for patients with repaired aneurysms, as despite recent evidence that aortic aneurysm prevalence has fallen with improvements in public health [28], [32], the fate of patients who survive SRA repair is concerning. "
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    ABSTRACT: Open surgery is widely used as a benchmark for the results of fenestrated endovascular repair of complex abdominal aortic aneurysms (AAA). However, the existing evidence stems from single-centre experiences, and may not be reproducible in wider practice. National outcomes provide valuable information regarding the safety of suprarenal aneurysm repair. Demographic and clinical data were extracted from English Hospital Episodes Statistics for patients undergoing elective suprarenal aneurysm repair from 1 April 2000 to 31 March 2010. Thirty-day mortality and five-year survival were analysed by logistic regression and Cox proportional hazards modeling. 793 patients underwent surgery with 14% overall 30-day mortality, which did not improve over the study period. Independent predictors of 30-day mortality included age, renal disease and previous myocardial infarction. 5-year survival was independently reduced by age, renal disease, liver disease, chronic pulmonary disease, and known metastatic solid tumour. There was significant regional variation in both 30-day mortality and 5-year survival after risk-adjustment. Regional differences in outcome were eliminated in a sensitivity analysis for perioperative outcome, conducted by restricting analysis to survivors of the first 30 days after surgery. Elective suprarenal aneurysm repair was associated with considerable mortality and significant regional variation across England. These data provide a benchmark to assess the efficacy of complex endovascular repair of supra-renal aneurysms, though cautious interpretation is required due to the lack of information regarding aneurysm morphology. More detailed study is required, ideally through the mandatory submission of data to a national registry of suprarenal aneurysm repair.
    PLoS ONE 05/2013; 8(5):e64163. DOI:10.1371/journal.pone.0064163 · 3.23 Impact Factor
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    • "Concomitantly, recent evidence have shown significant decreasing age-adjusted mortality trends from abdominal aortic aneurysm in Australia (1999 to 2006), New Zealand (1991 to 2007), England &Wales and Scotland (1997 to 2009), England & Wales (2001 to 2009), and in the United States (1979 to 2007) [49-54]. The factors associated with mortality changes related to aortic aneurysm and dissection are complex [52,53]. In the state of São Paulo, the increasing longevity of Brazilian population is likely to have contributed with the mortality rise since 1985. "
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    ABSTRACT: Background Aortic aneurysm and dissection are important causes of death in older people. Ruptured aneurysms show catastrophic fatality rates reaching near 80%. Few population-based mortality studies have been published in the world and none in Brazil. The objective of the present study was to use multiple-cause-of-death methodology in the analysis of mortality trends related to aortic aneurysm and dissection in the state of Sao Paulo, between 1985 and 2009. Methods We analyzed mortality data from the Sao Paulo State Data Analysis System, selecting all death certificates on which aortic aneurysm and dissection were listed as a cause-of-death. The variables sex, age, season of the year, and underlying, associated or total mentions of causes of death were studied using standardized mortality rates, proportions and historical trends. Statistical analyses were performed by chi-square goodness-of-fit and H Kruskal-Wallis tests, and variance analysis. The joinpoint regression model was used to evaluate changes in age-standardized rates trends. A p value less than 0.05 was regarded as significant. Results Over a 25-year period, there were 42,615 deaths related to aortic aneurysm and dissection, of which 36,088 (84.7%) were identified as underlying cause and 6,527 (15.3%) as an associated cause-of-death. Dissection and ruptured aneurysms were considered as an underlying cause of death in 93% of the deaths. For the entire period, a significant increased trend of age-standardized death rates was observed in men and women, while certain non-significant decreases occurred from 1996/2004 until 2009. Abdominal aortic aneurysms and aortic dissections prevailed among men and aortic dissections and aortic aneurysms of unspecified site among women. In 1985 and 2009 death rates ratios of men to women were respectively 2.86 and 2.19, corresponding to a difference decrease between rates of 23.4%. For aortic dissection, ruptured and non-ruptured aneurysms, the overall mean ages at death were, respectively, 63.2, 68.4 and 71.6 years; while, as the underlying cause, the main associated causes of death were as follows: hemorrhages (in 43.8%/40.5%/13.9%); hypertensive diseases (in 49.2%/22.43%/24.5%) and atherosclerosis (in 14.8%/25.5%/15.3%); and, as associated causes, their principal overall underlying causes of death were diseases of the circulatory (55.7%), and respiratory (13.8%) systems and neoplasms (7.8%). A significant seasonal variation, with highest frequency in winter, occurred in deaths identified as underlying cause for aortic dissection, ruptured and non-ruptured aneurysms. Conclusions This study introduces the methodology of multiple-causes-of-death to enhance epidemiologic knowledge of aortic aneurysm and dissection in São Paulo, Brazil. The results presented confer light to the importance of mortality statistics and the need for epidemiologic studies to understand unique trends in our own population.
    BMC Public Health 10/2012; 12(1):859. DOI:10.1186/1471-2458-12-859 · 2.26 Impact Factor
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