Aortic dissection incidence, management, and outcomes: national population-based study.

BACKGROUND

Aortic dissection (AD) management requires early medical therapy and surgical intervention in selected patients with type A aortic dissection (TAAD) or complicated type B aortic dissection (TBAD). The aim of this study was to assess incidence trends of AD in Sweden, and sex-based differences in management and outcomes over 25 years.

METHODS

The Swedish National Patient Register and Cause of Death Register were used to identify new AD between 1999 and 2023. Incidence, management, and survival outcomes were analysed relative to the general population by matching age, sex, and year.

RESULTS

Some 15 946 individuals had AD; 12 225 were admitted to hospital alive, and, of these, 6595 (53.9%) were treated medically. Of the 5630 surgically treated individuals, 4141 (73.6%) had TAAD and 1489 (26.4%) presented with TBAD. Incidence increased significantly to 9.32 per 100 000, with an annual percentage change (APC) of 1.4% (95% c.i. 1.2% to 1.6%). Incidence was lower for women (6.25 per 100 000) than men (10.52 per 100 000), but the APC was three-fold higher in women (APC 2.3% (95% c.i. 1.9% to 2.6%)) compared with men (APC 0.8% (95% c.i. 0.5% to 1.0%)). Women presented at an older age than men (mean of 71.9 versus 67.5 years, P < 0.001), were less likely to receive surgical treatment than men (women represented 37.8% of all dissection patients, but only 33.6% of surgically treated TAAD patients and 29.3% of surgically treated TBAD patients, P < 0.001), and had worse 10-year relative survival than men (medical management: women 70.9% and men 84.1%, P = 0.0041; TAAD surgical management: women 86.6% and men 94.9%, P < 0.0001; and TBAD surgical management: women 70.9% and men 87.5% P = 0.027).

CONCLUSION

The incidence of AD is increasing in Sweden, with persisting sex disparities in management and outcomes. These findings underscore the need for targeted interventions to improve the diagnosis, management, and prognostication of AD, especially in women.