Limitations
The present study is limited by its retrospective nature and that follow-up information was limited to data from a single healthcare network. As a result, it is possible that some patients were followed by cardiovascular specialists at outside institutions. We attempted to fill this gap using an automated inter-organization records exchange software (Care Everywhere), though we recognize that this is only available for patients who opt in. Furthermore, we did not assess whether patients were referred to a cardiologist or cardiac surgeon and were not seen. We did not include patient insurance status in our analysis, which would influence whether is patient is able to afford specialty care and imaging at regular intervals, regardless of income/SES. Lastly, cause of mortality is not reliably reported for patients dying outside the hospital setting, making it difficult to determine whether lack of surveillance resulted in increased mortality due to aortic-related events.