Alanna A Morris, Frederick A Masoudi, Abdul R Abdullah, Amitava Banerjee, LaPrincess C Brewer, Yvonne Commodore-Mensah, Peter Cram, Sarah C DeSilvey, Anika L Hines, Nasrien E Ibrahim, Elizabeth A Jackson, Karen E Joynt Maddox, Amgad N Makaryus, Ileana L Piña, Carla Patricia Rodriguez-Monserrate, Véronique L Roger, Fran F Thorpe, Kim A Williams
{"title":"2024 ACC/AHA Key Data Elements and Definitions for Social Determinants of Health in Cardiology: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Data Standards.","authors":"Alanna A Morris, Frederick A Masoudi, Abdul R Abdullah, Amitava Banerjee, LaPrincess C Brewer, Yvonne Commodore-Mensah, Peter Cram, Sarah C DeSilvey, Anika L Hines, Nasrien E Ibrahim, Elizabeth A Jackson, Karen E Joynt Maddox, Amgad N Makaryus, Ileana L Piña, Carla Patricia Rodriguez-Monserrate, Véronique L Roger, Fran F Thorpe, Kim A Williams","doi":"10.1161/HCQ.0000000000000133","DOIUrl":"10.1161/HCQ.0000000000000133","url":null,"abstract":"","PeriodicalId":49221,"journal":{"name":"Circulation-Cardiovascular Quality and Outcomes","volume":" ","pages":"e000133"},"PeriodicalIF":6.2,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142074376","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Emily P Zeitler, Boyang Bian, Robert I Griffiths, Dominic J Allocco, Thomas Christen, Kristine Roy, David J Cohen, Matthew R Reynolds
{"title":"Long-Term Clinical Outcomes Following the WATCHMAN Device Use in Medicare Beneficiaries.","authors":"Emily P Zeitler, Boyang Bian, Robert I Griffiths, Dominic J Allocco, Thomas Christen, Kristine Roy, David J Cohen, Matthew R Reynolds","doi":"10.1161/CIRCOUTCOMES.124.011007","DOIUrl":"10.1161/CIRCOUTCOMES.124.011007","url":null,"abstract":"<p><strong>Background: </strong>Long-term outcomes following left atrial appendage occlusion outside clinical trials and small registries are largely unknown. Collecting these data was a condition of US market authorization of the WATCHMAN device. The aim of this analysis was to evaluate the rates of stroke, bleeding, and death among Medicare beneficiaries following left atrial appendage occlusion implantation during initial commercial availability of the WATCHMAN left atrial appendage occlusion device overall and in important subgroups.</p><p><strong>Methods: </strong>All Medicare fee-for-service beneficiaries ≥65 years of age who underwent left atrial appendage occlusion from April 1, 2016, to August 31, 2020, were included based on the <i>International Classification of Diseases, Tenth Revision</i>, and Current Procedural Terminology codes. Over a 5-year follow-up period, the cumulative incidence over time of mortality, ischemic stroke, and major bleeding were calculated using the <i>International Classification of Diseases, Tenth Revision</i>, diagnosis codes for the full study cohort and within important prespecified subgroups.</p><p><strong>Results: </strong>WATCHMAN recipients (n=48 763) were a median of 77 (interquartile range, 72-82) years of age, 42% female, and mostly White (93%). The median CHA<sub>2</sub>DS<sub>2</sub>VASc score was 4 (interquartile range, 3-5) with prior major bleeding in 42% and prior stroke in 12%. At 5 years, death occurred in 44%, bleeding in 15% (with higher risk early following implantation), and ischemic stroke in 7%. Each of these end points was more common with greater baseline age. Male patients had greater 5-year mortality than female patients (46.9% versus 40.6%), but there was no difference between sexes in the rates of ischemic stroke (6.6% versus 7.5%) or major bleeding (14.9% for both). WATCHMAN recipients with prior ischemic stroke or a major bleeding event were older and frailer; these groups had higher rates of ischemic stroke, major bleeding, and death.</p><p><strong>Conclusions: </strong>Compared with patients enrolled in the pivotal clinical trials, Medicare beneficiaries undergoing WATCHMAN implantation were older, more female, and had more comorbid conditions. Substantial long-term mortality and major bleeding following WATCHMAN reflect the high-risk nature of the patient population, while the ischemic stroke rate was relatively low (<1.5% per year).</p>","PeriodicalId":49221,"journal":{"name":"Circulation-Cardiovascular Quality and Outcomes","volume":" ","pages":"e011007"},"PeriodicalIF":6.2,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11485207/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142373332","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Nobuhiro Ikemura, John A Spertus, Dan Nguyen, Zhuxuan Fu, Philip G Jones, Harmony R Reynolds, Sripal Bangalore, Balram Bhargava, Roxy Senior, Ahmed Elghamaz, Shaun G Goodman, Renato D Lopes, Radoslaw Pracoń, José López-Sendón, Aldo P Maggioni, Shun Kohsaka, Gregory A Roth, Harvey D White, Kreton Mavromatis, William E Boden, Fatima Rodriguez, Judith S Hochman, David J Maron
{"title":"International Variation in Health Status Benefits in Patients Undergoing Initial Invasive Versus Conservative Management for Chronic Coronary Disease: Insights From the ISCHEMIA Trial.","authors":"Nobuhiro Ikemura, John A Spertus, Dan Nguyen, Zhuxuan Fu, Philip G Jones, Harmony R Reynolds, Sripal Bangalore, Balram Bhargava, Roxy Senior, Ahmed Elghamaz, Shaun G Goodman, Renato D Lopes, Radoslaw Pracoń, José López-Sendón, Aldo P Maggioni, Shun Kohsaka, Gregory A Roth, Harvey D White, Kreton Mavromatis, William E Boden, Fatima Rodriguez, Judith S Hochman, David J Maron","doi":"10.1161/CIRCOUTCOMES.123.010534","DOIUrl":"10.1161/CIRCOUTCOMES.123.010534","url":null,"abstract":"<p><strong>Background: </strong>The ISCHEMIA trial (International Study of Comparative Health Effectiveness with Medical and Invasive Approaches) demonstrated greater health status benefits with an initial invasive strategy, as compared with a conservative one, for patients with chronic coronary disease and moderate or severe ischemia. Whether these benefits vary globally is important to understand to support global adoption of the results.</p><p><strong>Methods: </strong>We analyzed participants' disease-specific health status using the validated 7-item Seattle Angina Questionnaire (SAQ: >5-point differences are clinically important) at baseline and over 1-year follow-up across 37 countries in 6 international regions. The average effect of initial invasive versus conservative strategies on 1-year SAQ scores was estimated using Bayesian proportional odds regression and compared across regions.</p><p><strong>Results: </strong>Considerable regional variation in baseline health status was observed among 4617 participants (mean age=64.4±9.5 years, 24% women), with the mean SAQ summary scores of 67.4±19.5 in Eastern Europe participants (17% of the total), 71.4±15.4 in Asia-Pacific (18%), 74.9±16.7 in Central and South America (10%), 75.5±19.5 in Western Europe (26%), and 78.6±19.2 in North America (28%). One-year improvements in SAQ scores were greater in regions with lower baseline scores with initial invasive management (17.7±20.9 in Eastern Europe and 11.4±19.3 in North America), but similar in the conservative arm. Adjusting for baseline SAQ scores, similar health status benefits of an initial invasive strategy on 1-year SAQ scores were observed (ranging from 2.38 points [95% CI, 0.04-4.50] in North America to 4.66 points [95% CI, 2.46-6.94] in Eastern Europe), with an 88.3% probability that the difference in benefit across regions was <5 points.</p><p><strong>Conclusions: </strong>In patients with chronic coronary disease and moderate or severe ischemia, initial invasive management was associated with a consistent health status benefit across regions, with modest regional variability, supporting the international generalizability of health status benefits from invasive management of chronic coronary disease.</p><p><strong>Registration: </strong>URL: https://www.clinicaltrials.gov; Unique identifier: NCT01471522.</p>","PeriodicalId":49221,"journal":{"name":"Circulation-Cardiovascular Quality and Outcomes","volume":" ","pages":"e010534"},"PeriodicalIF":6.2,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11479829/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142299422","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Alexandra I Mansour, Milan Seth, Michael P Thompson, Mary Casey, Steven J Keteyian, Frank A Smith, Hitinder S Gurm, Devraj Sukul
{"title":"Use of a Liaison-Mediated Referral Strategy and Participation in Cardiac Rehabilitation After Percutaneous Coronary Intervention.","authors":"Alexandra I Mansour, Milan Seth, Michael P Thompson, Mary Casey, Steven J Keteyian, Frank A Smith, Hitinder S Gurm, Devraj Sukul","doi":"10.1161/CIRCOUTCOMES.124.010874","DOIUrl":"10.1161/CIRCOUTCOMES.124.010874","url":null,"abstract":"<p><strong>Background: </strong>Cardiac rehabilitation (CR) improves outcomes following percutaneous coronary intervention (PCI) but remains underutilized. A liaison-mediated referral (LMR), where a health care professional explains CR's benefits, addresses barriers to participation, and places a referral before discharge, may promote CR use. Our objective was to assess the impact of an LMR on CR participation after PCI.</p><p><strong>Methods: </strong>This was a retrospective study of patients who underwent PCI across 48 hospitals in Michigan between January 2021 and April 2022 and referred to CR before discharge. Clinical registry data were linked to administrative claims to identify the primary outcome, CR participation, defined as ≥1 CR session within 90 days of discharge. Bayesian hierarchical logistic regression was used to compare CR participation between patients with and without an LMR. For the secondary outcome, frailty proportional hazard modeling compared days elapsed between discharge and first CR session between liaison cohorts.</p><p><strong>Results: </strong>Among 9023 patients referred to CR after PCI, 4323 (47.9%) underwent an LMR (mean age, 69.3 [SD=11] years; 68.3% male) and 3390 (36.7%) attended ≥1 CR session within 90 days of discharge. The LMR cohort had a higher unadjusted CR participation rate (43.1% [95% CI, 41.5%-44.6%] versus 32.4% [95% CI, 31.1%-33.8%]; <i>P</i><0.001), a higher adjusted odds ratio of attending ≥1 CR session (adjusted odds ratio, 1.21; 95% credible interval, 1.07-1.38), and a shorter delay in attending the first CR session compared with the non-LMR cohort (28 [interquartile range, 19-42] versus 33 [interquartile range, 21-47] days; <i>P</i><0.001).</p><p><strong>Conclusions: </strong>An LMR was associated with higher odds of CR participation and may mitigate delays in CR enrollment. This referral strategy may improve CR participation and patient outcomes after PCI.</p>","PeriodicalId":49221,"journal":{"name":"Circulation-Cardiovascular Quality and Outcomes","volume":" ","pages":"e010874"},"PeriodicalIF":6.2,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142373342","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Geographic Variations of Trial Results In a World of Hurt.","authors":"John A Bittl","doi":"10.1161/CIRCOUTCOMES.124.011179","DOIUrl":"10.1161/CIRCOUTCOMES.124.011179","url":null,"abstract":"","PeriodicalId":49221,"journal":{"name":"Circulation-Cardiovascular Quality and Outcomes","volume":" ","pages":"e011179"},"PeriodicalIF":6.2,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142299421","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Communicating Personalized Benefits of Conservative versus Invasive Treatment of Chronic Coronary Disease: Reflections From the Risk Communication Literature.","authors":"Laura D Scherer, Daniel D Matlock","doi":"10.1161/CIRCOUTCOMES.124.011463","DOIUrl":"10.1161/CIRCOUTCOMES.124.011463","url":null,"abstract":"","PeriodicalId":49221,"journal":{"name":"Circulation-Cardiovascular Quality and Outcomes","volume":" ","pages":"e011463"},"PeriodicalIF":6.2,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142299419","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Dan D Nguyen, Carole Decker, Christina M Pacheco, Stacy L Farr, Christine Fuss, Ruth M Masterson Creber, Stephanie Pena, Nobuhiro Ikemura, Anezi I Uzendu, David J Maron, Judith S Hochman, John A Dodson, John A Spertus
{"title":"Developing an Individualized Patient Decision Aid for Chronic Coronary Disease Based on the ISCHEMIA Trial: A Mixed-Methods Study.","authors":"Dan D Nguyen, Carole Decker, Christina M Pacheco, Stacy L Farr, Christine Fuss, Ruth M Masterson Creber, Stephanie Pena, Nobuhiro Ikemura, Anezi I Uzendu, David J Maron, Judith S Hochman, John A Dodson, John A Spertus","doi":"10.1161/CIRCOUTCOMES.124.010923","DOIUrl":"10.1161/CIRCOUTCOMES.124.010923","url":null,"abstract":"<p><strong>Background: </strong>Pursuing initial invasive or conservative management of chronic coronary disease (CCD) is a preference-sensitive decision that should include shared decision-making. Communicating the benefits of either approach is challenging, as individual patients rarely achieve the population-averaged outcomes reported in clinical trials. Our objective was to develop a patient decision aid (PDA) with patient-specific estimates of outcomes for initial invasive versus conservative management of CCD, based on the ISCHEMIA trial (International Study of Comparative Health Effectiveness With Medical and Invasive Approaches).</p><p><strong>Methods: </strong>This was a multiphase mixed-methods study using focus groups of outpatients with CCD, caregivers, clinicians, and researchers. Focus groups were held in Kansas City, MO and New York City, NY between September 2021 and June 2022. Patients with CCD were included if they had a positive stress test within 1 year. Phase 1 focused on patient priorities for outcomes to guide treatment decisions. Phase 2 involved PDA development and refinement. Phase 3 involved further refinement and member checking. Key themes involving shared decision-making and treatment preferences were elicited from focus groups using a deductive approach to develop a PDA representing the outcomes most important to patients.</p><p><strong>Results: </strong>Of 46 patient and caregiver participants, the mean age was 63.5 years, 53% were female, 61% were White, 24% were Black, and 9% were Hispanic. When deciding between treatments, participants valued shared decision-making but generally deferred decisions to clinicians. The outcomes most important to participants were survival and quality of life, followed by physical functioning and symptoms. To represent these outcomes, participants favored simple visualizations, such as a speedometer or health meter. When deciding between treatment options, participants preferred to use the PDA collaboratively with a clinician instead of as a stand-alone tool.</p><p><strong>Conclusions: </strong>Our novel, patient-centered approach to developing a PDA for CCD with patient-specific outcomes has the potential to rapidly translate clinical trial results to individual patients and support shared decision-making.</p>","PeriodicalId":49221,"journal":{"name":"Circulation-Cardiovascular Quality and Outcomes","volume":" ","pages":"e010923"},"PeriodicalIF":6.2,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142299420","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Carlos J Rodriguez, Mercedes C Carnethon, Donna K Arnett, Donald M Lloyd-Jones
{"title":"Challenges and Opportunities in Disease Surveillance and Cardiovascular Epidemiology for the Centennial Collection.","authors":"Carlos J Rodriguez, Mercedes C Carnethon, Donna K Arnett, Donald M Lloyd-Jones","doi":"10.1161/CIRCOUTCOMES.123.010011","DOIUrl":"https://doi.org/10.1161/CIRCOUTCOMES.123.010011","url":null,"abstract":"","PeriodicalId":49221,"journal":{"name":"Circulation-Cardiovascular Quality and Outcomes","volume":"17 10","pages":"e010011"},"PeriodicalIF":6.2,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142478881","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Martin Seifert, Daniel Meretz, Anja Haase-Fielitz, Christian Georgi, Marwin Bannehr, Viviane Moeller, Gerhard Janßen, Peter Bramlage, Hans Heinrich Minden, Dirk Grosse-Meininghaus, Christian Butter
{"title":"Impact of Physical Activity in Patients With Atrial Fibrillation Undergoing Catheter Ablation: The Multicenter Randomized BE-ACTION Trial.","authors":"Martin Seifert, Daniel Meretz, Anja Haase-Fielitz, Christian Georgi, Marwin Bannehr, Viviane Moeller, Gerhard Janßen, Peter Bramlage, Hans Heinrich Minden, Dirk Grosse-Meininghaus, Christian Butter","doi":"10.1161/CIRCOUTCOMES.124.010877","DOIUrl":"10.1161/CIRCOUTCOMES.124.010877","url":null,"abstract":"<p><strong>Background: </strong>Arrhythmia recurrence after pulmonary vein isolation (PVI) is common. We conducted a multicenter, randomized trial to determine the impact of increased physical activity on atrial fibrillation recurrence after PVI.</p><p><strong>Methods: </strong>From 2018 to 2020, we randomly assigned 200 patients with atrial fibrillation to the ACTION or NO-ACTION group in 4 different centers in the local country of Brandenburg, Germany. Patients were eligible if they were scheduled to undergo PVI, aged ≥50 to ≤77 years, body mass index ≥23 to ≤35 kg/m<sup>2</sup>, and accepted wearing an activity tracker allowing 24-hour activity monitoring via mobile app. Patients in the ACTION group were actively remote-controlled via transmitted activity data by a physiotherapist, and individual motivational interviewing call sessions were scheduled with each ACTION patient every 2 weeks. The primary end point was the composite of recurrence of any atrial arrhythmia >30 seconds, additional ablation procedure, cardioversion, and new onset of antiarrhythmic drugs earliest after 90 days after index PVI over 12 months.</p><p><strong>Results: </strong>Overall, the median age of patients was 66 (interquartile range, 61-71) years, 33.5% were women, and 52% had persistent atrial fibrillation. The number of steps per day increased in both groups of patients from baseline to 12 months (<i>P</i><0.001). The absolute increase in steps per day did not differ between patients in the ACTION group with +3205 steps (597-4944) compared with those in the NO-ACTION group +2423 steps (17-4284), <i>P</i>=0.325. Unadjusted intention-to-treat analysis showed no difference in the primary composite end point in the ACTION group (27.3%) versus the NO-ACTION group (32.7%), <i>P</i>=0.405.</p><p><strong>Conclusions: </strong>Physical activity improved in patients after PVI. The present randomized controlled trial shows that activity tracker and motivational calls to increase physical activity versus activity tracker alone did not reduce the occurrence of the primary composite end point of atrial fibrillation recurrence or the absolute increase in steps per day.</p><p><strong>Registration: </strong>URL: https://www.cochranelibrary.com; Unique identifier: DRKS00012914.</p>","PeriodicalId":49221,"journal":{"name":"Circulation-Cardiovascular Quality and Outcomes","volume":" ","pages":"e010877"},"PeriodicalIF":6.2,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142113974","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Eduardo Bossone, Kim A Eagle, Christoph A Nienaber, Santi Trimarchi, Himanshu J Patel, Thomas G Gleason, Chih-Wen Pai, Daniel G Montgomery, Reed E Pyeritz, Arturo Evangelista, Alan C Braverman, Derek R Brinster, Dan Gilon, Marco Di Eusanio, Marek P Ehrlich, Kevin M Harris, Truls Myrmel, Eric M Isselbacher
{"title":"Acute Aortic Dissection: Observational Lessons Learned From 11 000 Patients.","authors":"Eduardo Bossone, Kim A Eagle, Christoph A Nienaber, Santi Trimarchi, Himanshu J Patel, Thomas G Gleason, Chih-Wen Pai, Daniel G Montgomery, Reed E Pyeritz, Arturo Evangelista, Alan C Braverman, Derek R Brinster, Dan Gilon, Marco Di Eusanio, Marek P Ehrlich, Kevin M Harris, Truls Myrmel, Eric M Isselbacher","doi":"10.1161/CIRCOUTCOMES.123.010673","DOIUrl":"10.1161/CIRCOUTCOMES.123.010673","url":null,"abstract":"<p><strong>Background: </strong>Over the past 25 years, diagnosis and therapy for acute aortic dissection (AAD) have evolved. We aimed to study the effects of these iterative changes in care.</p><p><strong>Methods: </strong>Patients with nontraumatic AAD enrolled in the International Registry of Acute Aortic Dissection (61 centers; 15 countries) were divided into time-based tertiles (groups) from 1996 to 2022. The impact of changes in diagnostics, therapeutic care, and in-hospital and 3-year mortality was assessed. Cochran-Armitage trend and Jonckheere-Terpstra tests were conducted to test for any temporal trend.</p><p><strong>Results: </strong>Each group consisted of 3785 patients (mean age, ≈62 years old; ≈65.5% males); nearly two-thirds had type A AAD. Over time, the rates of hypertension increased from 77.8% to 80.4% (<i>P</i>=0.002), while smoking (34.1% to 30.6%, <i>P</i>=0.033) and atherosclerosis decreased (25.6%-16.6%; <i>P</i><0.001). Across groups, the percentage of surgical repair of type A AAD increased from 89.1% to 92.5% (<i>P</i><0.001) and was associated with decreased hospital mortality (from 24.1% in group 1 to 16.7% in group 3; <i>P</i><0.001). There was no difference in 3-year survival (<i>P</i>=0.296). For type B AAD, stent graft therapy (thoracic endovascular aortic repair) was used more frequently (22.3%-35.9%; <i>P</i><0.001), with a corresponding decrease in open surgery. Endovascular in-hospital mortality decreased from 9.9% to 6.2% (<i>P</i>=0.003). As seen with the type A AAD cohort, overall 3-year mortality for patients with type B AAD was consistent over time (<i>P</i>=0.084).</p><p><strong>Conclusions: </strong>Over 25 years, substantial improvements in-hospital survival were associated with a more aggressive surgical approach for patients with type A AAD. Open surgery has been partially supplanted by thoracic endovascular aortic repair for complicated type B AAD, and in-hospital mortality has decreased over the time period studied. Postdischarge survival for up to 3 years was similar over time.</p>","PeriodicalId":49221,"journal":{"name":"Circulation-Cardiovascular Quality and Outcomes","volume":" ","pages":"e010673"},"PeriodicalIF":6.2,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141983717","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}