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.