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

Abstract Introduction Aortic dissection (AD) management requires early medical therapy and surgical intervention in selected patients with type A aortic dissection (TAAD) or complicated type B dissection (TBAD). The aim of this study was to assess incidence trends of AD in Sweden, and sex-based differences in management and outcome over 25 years. Methods 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 with relative survival comparing general population matching age, sex and year. Results Some 15946 individuals had AD, 12225 were admitted to hospital alive, and 6595 (53.9%) treated medically. Of the 5630 surgically treated, 4141 (73.6%) had TAAD and 1489 (26.4%) presented with TBAD. Incidence increased significantly to 9.32/100,000, with an annual percentage change (APC) 1.4% (95%CI 1.2-1.6%). Incidence was lower for women (6.25/100,000) than men (10.52/100,000), but the incidence was threefold higher in women (APC 2.3% 95% CI 1.9-2.6%) compared with men (0.8% 95% CI 0.5-1.0%). Women presented at an older age (mean 71.9 years; men 67.5 years, p < 0.001), were less likely to receive surgical treatment (37.8% AD; 33.6% of surgical TAAD; 29.3% of surgical TBAD, p < 0.001) and had a worse 10 year relative survival (medical: women 70.9%; men 84.1% p = 0.0041, surgical TAAD: women 86.6% men 94.9% p < 0.0001, surgical TBAD: women 70.9%; 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.