Temporal trends in management and outcome of pulmonary embolism: a single-centre experience

Abstract

Background Real-world data on the impact of advances in risk-adjusted management on the outcome of patients with pulmonary embolism (PE) are limited. Methods To investigate temporal trends in treatment, in-hospital adverse outcomes and 1-year mortality, we analysed data from 605 patients [median age, 70 years (IQR 56-77) years, 53% female] consecutively enrolled in a single-centre registry between 09/2008 and 08/2016. Results Over the 8-year period, more patients were classified to lower risk classes according to the European Society of Cardiology (ESC) 2014 guideline algorithm while the number of high-risk patients with out-of-hospital cardiac arrest (OHCA) increased. Although patients with OHCA had an exceptionally high in-hospital mortality rate of 59.3%, the rate of PE-related in-hospital adverse outcomes (12.2%) in the overall patient cohort remained stable over time. The rate of reperfusion treatment was 9.6% and tended to increase in high-risk patients. We observed a decrease in the median duration of in-hospital stay from 10 (IQR 6-14) to 7 (IQR 4-15) days, an increase of patients discharged early from 2.1 to 12.2% and an increase in the use of non-vitamin K-dependent oral anticoagulants (NOACs) from 12.6 to 57.2% in the last 2 years (09/2014-08/2016) compared to first 6 years (09/2008-08/2014). The 1-year mortality rate (16.9%) remained stable throughout the study period. Conclusion In-hospital adverse outcomes and 1-year mortality remained stable despite more patients with OHCA, shorter in-hospital stays, more patients discharged early and a more frequent NOAC use.

Validation of a fast prognostic score for risk stratification of normotensive patients with acute pulmonary embolism

“…The 2014 and the recently presented 2019 ESC guidelines suggest that the assessment of clinical variables, myocardial injury markers and RV function on imaging allows the identification of normotensive PE patients at higher risk who require monitoring and reperfusion therapy if haemodynamic decompensation appears [ 1 , 13 ]. Several cohort studies demonstrated that the 2014 ESC algorithm reliably stratifies PE patients in different risk categories [ 10 , 15 – 18 ]. Furthermore, a recently published meta-analysis including 7,536 patients from 22 studies confirmed the importance of RV dysfunction, even in “low risk” patients identified by clinical criteria (PESI < 86 points, sPESI 0 points or all Hestia criteria absent) [ 3 ].…”

Changing Trends in Hospital Admissions for Pulmonary Embolism in Spain from 2001 to 2018

“…Despite an increasing burden of comorbidities for PE patients, the LOHS improved over time in our study, as other authors have described [ 14 , 17 ]. Although some health systems have provided an incentive for shortening the LOHS, some factors that may contribute to these trends are the more frequent use of the option of early discharge for selected low-risk patients and the advances in PE treatment, including the availability of low-molecular-weight heparin [ 9 ] and direct oral anticoagulants [ 14 ], which are related to a decreased LOHS [ 32 , 33 , 34 ].…”

High-sensitivity troponin I for risk stratification in normotensive pulmonary embolism

“…The Pulmonary Embolism Registry of Göttingen (PERGO) prospectively includes consecutive patients with objectively confirmed PE ≥18 years of age admitted to the University Medical Center Göttingen, Germany. The study protocol has been described in detail previously [ 13 , 14 ]. Briefly, patient recruitment is performed by daily screening of new admissions to the emergency department and of reports of conducted computed tomography pulmonary angiographies (CTPAs).…”