Causes of Death in Patients with Aortic Aneurysmal Disease (1987-2014)

Abstract

Introduction: This study examined the cause of death of patients with aortic aneurysms treated for this disease between 1987 and 2014 to understand the current natural history of this condition. Methods: This study results from analysis of a prospectively maintained data base of patients treated by the author. Data points were obtained from practice records and supplemented by data made available through CHeRL (Centre for electronic Health Record Linkage). Six hundred and twenty two patients were treated consecutively between 1987 and 2014. At closure of the study in 2014, 402 patients had died and date of death was available. Cause of death was available by ICD (International Classification of Diseases) 9 or 10 in 89% of patients. Method of treatment of aneurysmal disease was available in all patients. Ethics approval for this study was obtained from the Centre for Health Research, Cancer Institute, New South Wales Department of Health. Statistical analysis was conducted by comparison of mean ±95% conference interval. Where appropriate contingency table analysis was constructed. Statistical significance was accepted at P < 0.05. Results: Mean age at presentation was 75.6 years (95%C.I. 74.8 - 76.3). Mean age at death was 81 years (95%C.I. 80.2 - 81.7). Predicted age at death based on Australian Bureau of Statistics life tables was 86.25 years (95%C.I. 85.8 - 86.8). Between 1987 and 1999, mean age at presentation was 74.5 years (95%C.I. 73.3 - 75, n = 304, Females = 78). Between 2000 and 2014, mean age at presentation was 75.3 years (95%C.I. 74.1 - 75, n = 318, females = 54). The difference for females presenting 1987 to 1999 compared 2000 to 2014 was significant, p < 0.01. Death was due to the following causes unknown 11%, cardiovascular disease 27.7%, pulmonary related disease 9.7% and aortic related disease 20.6%. Patients died of aortic related causes significantly earlier (within 2 years) compared to patients with other causes of death (5 to 8 years) due to presentation with ruptured aortic aneurysm. Cardiovascular related causes of death, malignancy and pulmonary related causes of death accounted for the majority of deaths post-treatment. There was no significant difference in length of survival among patients dying from these causes. Conclusion: Patients with successfully treated aneurysmal disease can expect to survive 5 - 8 years post-treatment. Presentation with aortic aneurysm rupture results in significantly shortened life expectancy. Patients presenting in the ninth decade of life and with less than 5 years life expectancy may not benefit from elective repair of aortic aneurysm.