Analysis of National Trends in Admissions for Pulmonary Embolism

Smith, Sean B.; Geske, Jeffrey B.; Kathuria, Parul; Cuttica, Michael J.; Schimmel, Daniel; Courtney, D. Mark; Waterer, Grant; Wunderink, Richard G.

doi:10.1016/j.chest.2016.02.638

Cited by 145 publications

(121 citation statements)

References 35 publications

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“…Increasing admission rates for aPE, with estimates as high as a 237% since 1993 and 80% between 1998 and 2006, has put substantial strain on healthcare systems. However, development of early discharge guidelines in the last decade appears to provide a cost‐effective and safe alternative.…”

Section: Early Discharge and Outpatient Managementmentioning

confidence: 99%

Acute pulmonary embolism: a concise review of diagnosis and management

Hepburn-Brown

Darvall

Hammerschlag

2019

Internal Medicine Journal

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An acute pulmonary embolism (aPE) is characterised by occlusion of one or more pulmonary arteries. Physiological disturbance may be minimal, but often cardiac output decreases as the right ventricle attempts to overcome increased afterload. Additionally, ventilation‐perfusion mismatches can develop in affected vascular beds, reducing systemic oxygenation. Incidence is reported at 50–75 per 100 000 in Australia and New Zealand, with 30‐day mortality rates ranging from 0.5% to over 20%. Incidence is likely to increase with the ageing population, increased survival of patients with comorbidities that are considered risk factors and improving sensitivity of imaging techniques. Use of clinical prediction scores, such as the Wells score, has assisted in clinical decision‐making and decreased unnecessary radiological investigations. However, imaging (i.e. computed tomography pulmonary angiography or ventilation‐perfusion scans) is still necessary for objective diagnosis. Anti‐coagulation remains the foundation of PE management. Haemodynamically unstable patients require thrombolysis unless absolutely contraindicated, while stable patients with right ventricular dysfunction or ischaemia should be aggressively anti‐coagulated. Stable patients with no right ventricular dysfunction can be discharged home early with anti‐coagulation and review. However, treatment should be case dependent with full consideration of the patient’s clinical state. Direct oral anti‐coagulants have become an alternative to vitamin K antagonists and are facilitating shorter hospital admissions. Additionally, duration of anti‐coagulation must be decided by considering any provoking factors, bleeding risk and comorbid state. Patients with truly unprovoked or idiopathic PE often require indefinite treatment, while in provoked cases it is typically 3 months with some patients requiring longer periods of 6–12 months.

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Section: Early Discharge and Outpatient Managementmentioning

confidence: 99%

Acute pulmonary embolism: a concise review of diagnosis and management

Hepburn-Brown

Darvall

Hammerschlag

2019

Internal Medicine Journal

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“…In the study by Jimenez et al on 23858 patients between 2001 and 2013, while the rate It has been observed seen that the hospitalization length and high hospital costs has shortened over time due to increased experience of physicians and increased use of LMWHs. In a study conducted in USA, the median hospitalization length was reported to have decreased from 8 days to 4 days [1]. In another study, the median hospitalization length decreased from 13.6 days to 9.3 days within a 13-year period [10].…”

Section: Discussionmentioning

confidence: 99%

“…In particular, the detection of clinically insignificant patients can contribute to a decreased mortality rate. In a study conducted in USA, the mortality rate was reported to decrease from 7.1% to 3.2% over 20 years [1]. In another study conducted in Australia, it was revealed that the mortality rate decreased over years but that PTE was still an important cause of mortality and morbidity in females and the elderly population [4].…”

Section: Discussionmentioning

confidence: 99%

“…In a study conducted in USA the incidence of PTE was reported to increase from 23/100,000 to 65/100,000 [1]. On the other hand, in a study conducted in Canada, no significant change was observed in the incidence of PTE in the last decade [2].…”

Section: Introductionmentioning

confidence: 90%

“…Moreover, improvements, such as the development of new anticoagulants and mechanical interventions, have occurred in the treatment of PTE. In parallel with all these improvements, data on the incidence and outcomes of the disease seems to be restricted.In a study conducted in USA the incidence of PTE was reported to increase from 23/100,000 to 65/100,000 [1]. On the other hand, in a study conducted in Canada, no significant change was observed in the incidence of PTE in the last decade [2].…”

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confidence: 90%

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Does the Incidence and Mortality of Pulmonary Thromboembolism Change Over the Years?

Özsu¹,

Durmuş²,

Coşkuner³

et al. 2017

Turk Thorac J

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OBJECTIVES:In the last 20 years, with the use of computed tomography (CT) angiography, the number of patients diagnosed with pulmonary thromboembolism (PTE) has increased. At the same time, data show that pulmonary embolism mortality has also reduced in this duration. MATERIAL AND METHODS:In this study, we analyzed records of patients with PTE (using ICD's) in the hospital automation system from 2001 to 2013. Data regarding age, sex, date of diagnosis, diagnosis of cancer, hemodynamic status, initial and maintenance treatment, hospital length of stay, and hospital mortality were recorded. Primary endpoints of the study were hospital length of stay and all-cause hospital mortality. RESULTS:The total number of patients included in the study was 1185. The median age was 61 years in 2001 and 71 years in 2013. The number of patients who were diagnosed using CT increased from 10% to 92.8%. Between 2001 and 2013, the number of patients diagnosed with PTE increased, and of all patients with PTE, 13.7% was diagnosed in 2009. The hospital length of stay of 13 days declined to 9 days. The use of a vena cava filter in 2007 was 1.1% and that in 2013 was 4.6%. Mortality rate was 15%, however hospital mortality did not significantly differ over the years but varied between 9.4% and 18.8%. Increased use of thrombolytics in patients with massive PTE has been observed over the years. Massive PTE ratio in 2006 was 8.5% and thrombolytic use was 5.8%, however in 2013, these ratios were 2.6%, 6% respectively (p=0.017). CONCLUSION:Finally, despite the increased number of patients diagnosed with PTE over the years, the mortality rate was not observed to have changed from 2001 to 2013. KEYWORDS:Pulmonary thromboembolism, heparin, thrombolytic, mortality, incidence INTRODUCTIONPulmonary thromboembolism (PTE) is an important public health concern that causes mortality and morbidity. Its non-specific symptoms and findings lead to difficulties in confirming its diagnosis. However, with the use of computed tomography (CT) angiography in recent years, an important step has been taken in the diagnosis of PTE. Moreover, improvements, such as the development of new anticoagulants and mechanical interventions, have occurred in the treatment of PTE. In parallel with all these improvements, data on the incidence and outcomes of the disease seems to be restricted.In a study conducted in USA the incidence of PTE was reported to increase from 23/100,000 to 65/100,000 [1]. On the other hand, in a study conducted in Canada, no significant change was observed in the incidence of PTE in the last decade [2]. A study was conducted on 60853 patients in Italy, and an increase was found in the incidence of PTE in the last 10 years [3]. In our study, the data of patients diagnosed with PTE between 2001 and 2013 were obtained from hospital recordings and were analyzed. MATERIAL AND METHODSIn our study, the records of patients diagnosed with PTE between 2001 and 2013 were obtained from the hospital's automations system (with the International Classification of Di...

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Venous Thromboembolism

Tritschler

Kraaijpoel

Gal

et al. 2018

JAMA

252

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enous thromboembolism (VTE), comprising deep vein thrombosis (DVT) and pulmonary embolism (PE), is a common and potentially fatal disease. The estimated incidence of a first acute VTE is 0.7 to 1.4 per 1000 person-years and is mostly observed in patients older than 55 years. [1][2][3][4] While the incidence of DVT has remained constant over time, 5 hospital admissions for PE in the United States more than doubled over the last decades, 6 partly because of widespread use of sensitive imaging techniques detecting smaller, potentially insignificant emboli. 7 Even though the in-hospital case-fatality rate of PE has decreased in the United States between 1999 and 2008, 8 about 30% of patients with PE die within the first year after diagnosis. 4 The socioeconomic effect of VTE is significant, with estimated annual costs ranging from $13.5 billion to $27.2 billion in the United States. 9Clinical signs and symptoms of DVT include unilateral leg pain, redness, swelling, edema, warmth, and tenderness. Pulmonary embolism may present with dyspnea, chest pain, hemoptysis, syncope, tachycardia, and hypotension. The clinical presentation of VTE is often not specific, and DVT can be indistinguishable from cellulitis, hematoma, superficial thrombophlebitis, and congestive heart failure. Pulmonary embolism presents similarly to myocardial infarction, congestive heart failure, and other diseases. Consequently, imaging is needed to confirm the diagnosis of VTE. The diagnosis of VTE is made in a sequence of steps including assessment of the pretest probability, followed by D-dimer testing and imaging as appropriate (Figure 1). When VTE is diagnosed, immediate initiation of anticoagulant therapy is imperative. The choice among different anticoagulant agents and the duration of treatment are based IMPORTANCE Venous thromboembolism (VTE), comprising deep vein thrombosis (DVT) and pulmonary embolism (PE), is a common and potentially fatal disease.OBJECTIVE To summarize the advances in diagnosis and treatment of VTE of the past 5 years.EVIDENCE REVIEW A systematic search was conducted in EMBASE Classic, EMBASE, Ovid MEDLINE, and other nonindexed citations using broad terms for diagnosis and treatment of VTE to find systematic reviews and meta-analyses, randomized trials, and prospective cohort studies published between January 1, 2013, and July 31, 2018. The 10th edition of the American College of Chest Physicians Antithrombotic Therapy Guidelines was screened to identify additional studies. Screening of titles, abstracts, and, subsequently, full-text articles was performed in duplicate, as well as data extraction and risk-of-bias assessment of the included articles.FINDINGS Thirty-two articles were included in this review. The application of an age-adjusted D-dimer threshold in patients with suspected PE has increased the number of patients in whom imaging can be withheld. The Pulmonary Embolism Rule-Out Criteria safely exclude PE when the pretest probability is low. The introduction of direct oral anticoagulants has allowed for a simpli...

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Analysis of National Trends in Admissions for Pulmonary Embolism

Cited by 145 publications

References 35 publications

Acute pulmonary embolism: a concise review of diagnosis and management

Acute pulmonary embolism: a concise review of diagnosis and management

Does the Incidence and Mortality of Pulmonary Thromboembolism Change Over the Years?

Venous Thromboembolism

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