Imaging surveillance for thoracic aortic aneurysms in Medicare beneficiaries

Background: Regular imaging surveillance is guideline-recommended for the management of thoracic aortic aneurysm (TAA) but has not been well described in clinical practice. Here we evaluated the frequency of imaging procedures and associated outcomes, procedures, and healthcare costs in patients with TAA. Methods: A retrospective cohort study of inpatient and professional claims for 28,459 Medicare beneficiaries age ≥65 years with a diagnosis of TAA between 2017 and 2019 was performed. Imaging types (computed tomography, magnetic resonance angiography, or transthoracic echocardiography) were identified from professional claims for beneficiaries with TAA during the 2 calendar years and categorized as any (yes vs no) and number of imaging procedures. Multivariable logistic regression was used to evaluate the association of patient and clinical factors with undergoing any imaging and to compare clinical outcomes (surgical intervention, all-cause mortality, and hospitalization) across imaging types. Results: A total of 12,968 beneficiaries (45.6%) underwent imaging during the study period, including 24.9% with 1 image, 13.07% with 2 images, and 7.6% with ≥3 images. Younger age, female sex, white race/ethnicity, and lower comorbidity score were independently associated with undergoing any imaging. Compared to receiving no imaging and after risk adjustment, beneficiaries with ≥3 images had more frequent surgical interventions (0.4% vs 6.6%; P < .001) and all-cause hospitalization (41.6% vs 75.9%; P < .001) but lower mortality (16.4% vs 13.3%; P < .001). Conclusions: Imaging for TAA is underutilized among Medicare beneficiaries, and more frequent imaging is associated with more frequent surgical intervention, hospitalization, and lower mortality.