Deaths related to pulmonary embolism and cardiovascular events before and during the 2020 COVID-19 pandemic: An epidemiological analysis of data from an Italian high-risk area

Voci, Davide; Fedeli, Ugo; Farmakis, Ioannis; Hobohm, Lukas; Keller, Karsten; Valerio, Luca; Schievano, Elena; Amidei, Claudio Barbiellini; Konstantinides, Stavros; Kucher, Nils

doi:10.1016/j.thromres.2022.02.008

Cited by 20 publications

(18 citation statements)

References 36 publications

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“…On the other hand, some single-center studies did not show a risk of PE in COVID-19 in either sex [ 97 ]. This could possibly be attributed to the low power or the fact that COVID-19 itself is seen more commonly in men, with a pooled prevalence of 55.00 (51.43–56.58; I[2] = 99.5%; p < 0.001) [ 98 ], which leads to a false positive association of the male sex with PE in COVID-19. The unfavorable outcomes in male sex persisted with a 45% increase in deaths in men as compared to 14% increase of deaths in women in an Italian study of PE-related mortality in patients with COVID-19.…”

Section: Resultsmentioning

confidence: 99%

Pulmonary Embolism in Women: A Systematic Review of the Current Literature

Thachil

Nagraj

Kharawala

et al. 2022

JCDD

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Cardiovascular disease is the leading cause of death in women. Pulmonary embolism (PE) is the third most-common cause of cardiovascular death, after myocardial infarction (MI) and stroke. We aimed to evaluate the attributes and outcomes of PE specifically in women and explore sex-based differences. We conducted a systematic review of the literature using electronic databases PubMed and Embase up to 1 April 2022 to identify studies investigating PE in women. Of the studies found, 93 studies met the eligibility criteria and were included. The risk of PE in older women (especially >40 years of age) superseded that of age-matched men, although the overall age- and sex-adjusted incidence of PE was found to be lower in women. Risk factors for PE in women included age, rheumatologic disorders, hormone replacement therapy or oral contraceptive pills, pregnancy and postpartum period, recent surgery, immobilization, trauma, increased body mass index, obesity, and heart failure. Regarding pregnancy, a relatively higher incidence of PE has been observed in the immediate postpartum period compared to the antenatal period. Women with PE tended to be older, presented more often with dyspnea, and were found to have higher NT-proBNP levels compared to men. No sex-based differences in in-hospital mortality and 30-day all-cause mortality were found. However, PE-related mortality was higher in women, particularly in hemodynamically stable patients. These differences form the basis of future research and outlets for reducing the incidence, morbidity, and mortality of PE in women.

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Section: Resultsmentioning

confidence: 99%

Pulmonary Embolism in Women: A Systematic Review of the Current Literature

Thachil

Nagraj

Kharawala

et al. 2022

JCDD

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“…By contrary, diabetes-related mortality peaked in March-April when the Veneto region was hit by the first COVID-19 epidemic wave; such excess mortality was larger in the male gender. During the second epidemic wave in late 2020, when mortality from all causes reached the highest peak in the region [6] , unprecedented high levels of diabetes-related mortality were observed in both genders.…”

Section: Discussionmentioning

confidence: 99%

“…Underreporting of COVID-19 can partly explain the mortality increase for diabetes and other chronic diseases; older individuals with cardiovascular comorbidities and diabetes mellitus were particularly vulnerable to COVID-19 [6] . However, the excess mortality could also be related to the indirect effects of the pandemic: some patients inappropriately avoided contact or experienced difficulties in accessing healthcare professionals, which may have contributed to poor glucose control or inadequate clinical management of the complications of the disease.…”

Section: Introductionmentioning

confidence: 99%

Diabetes as a cause of death across different COVID-19 epidemic waves

Fedeli

Casotto

Schievano

et al. 2022

Diabetes Research and Clinical Practice

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“…Several studies reported a substantial increase in the number of all-cause and cardiovascular mortality during the COVID-19 pandemic [35,36]. COVID-19 itself was the main cause of death or a concomitant cause in 8 to 9 out of 10 excess deaths [6].…”

Section: Discussionmentioning

confidence: 99%

“…These symptoms largely overlap with the typical symptoms observed in the clinical presentation of patients with acute pulmonary embolism (PE). In this context, thrombotic and thromboembolic complications such as PE have been described as a frequent and relevant complication of COVID-19 infection across several countries in 2020 [4][5][6][7]. From a pathophysiological point of view, it is still a matter of debate whether venous thromboembolism (VTE), or in situ immunothrombosis, or both, may cause contrast-filling defects in computed tomography pulmonary angiography (CTPA) when PE is diagnosed [8,9].…”

Section: Introductionmentioning

confidence: 99%

COVID-19 infection and its impact on case-fatality in patients with pulmonary embolism

Hobohm

Sagoschen

Farmakis

et al. 2022

European Heart Journal

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Background Although a high prevalence of pulmonary embolism (PE) has been reported as a complication during severe COVID-19 infections in critical ill patients, nationwide data of hospitalized patients with COVID-19 with PE is still limited. Thus, we sought to analyze seasonal trends and predictors of in-hospital case-fatality in patients with COVID-19 and PE in Germany. Methods We used the German nationwide inpatient sample to analyze all data on hospitalizations for COVID-19 patients with and without PE in Germany during the year 2020 and to compare changes of PE prevalence to 2019. Results We analyzed data of 176,137 hospitalizations because of COVID-19 in 2020. Among those, PE was recorded in 1.9% (n=3,362) of discharge or death certificates. Almost one third of patients with COVID-19 and PE died during the in-hospital course (28.7%). The case-fatality rate increased with patients' age peaking in the 9th life-decade. Regardless of COVID-19, 196,203 inpatients were diagnosed with PE in Germany between 2019 and 2020. The number of PE hospitalizations were widely equally distributed between both years (98,485 vs. 97,718), while the case-fatality rate of all patients with PE was slightly lower in 2019 compared to 2020 (12.7% vs. 13.1%, P<0.001). In contrast, considerable differences in prevalence and case-fatality were demonstrated in 2020 regarding PE patients with and without COVID-19 infection (28.7% vs. 13.1%, P<0.001) (Figure 1). A COVID-19-infection was associated with a 2.8-fold increased risk of case-fatality in patients with PE (OR 2.81, 95% CI 1.66–2.12, P<0.001). Conclusions In Germany, the prevalence of PE events complicating hospitalizations was similar in 2019 and 2020. However, the fatality rate among patients with COVID-19-associated PE was substantially higher than that in those without either COVID-19 or PE, indicating an additive prognostic effect of these two conditions. Funding Acknowledgement Type of funding sources: None.

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Deaths related to pulmonary embolism and cardiovascular events before and during the 2020 COVID-19 pandemic: An epidemiological analysis of data from an Italian high-risk area

Cited by 20 publications

References 36 publications

Pulmonary Embolism in Women: A Systematic Review of the Current Literature

Pulmonary Embolism in Women: A Systematic Review of the Current Literature

Diabetes as a cause of death across different COVID-19 epidemic waves

COVID-19 infection and its impact on case-fatality in patients with pulmonary embolism

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