Trends in mortality related to pulmonary embolism in the European Region, 2000–15: analysis of vital registration data from the WHO Mortality Database

Barco, Stefano; Mahmoudpour, Seyed Hamidreza; Valerio, Luca; Klok, Frederikus A.; Münzel, Thomas; Middeldorp, Saskia; Ageno, Walter; Cohen, Alexander T.; Hunt, Beverley J.; Konstantinides, Stavros

doi:10.1016/s2213-2600(19)30354-6

Cited by 211 publications

(162 citation statements)

References 74 publications

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“…We observed a continuous decrease in IHM from 2001 to 2018, a finding consistent with the decreasing trend reported by Barco et al when they analyzed vital registration data from the WHO Mortality Database (2000–2015) [ 8 ]. Among potential explanations are the temporal changes in pharmacological and interventional treatments for PE [ 9 ] and more effective referral to high-volume centers [ 38 ].…”

Section: Discussionsupporting

confidence: 91%

“…Longitudinal data have revealed an increasing tendency in annual PE incidence rates over time [ 4 , 5 , 6 , 7 ], although data from recent years are lacking. This finding could be due to an increasing number of patients with severe comorbidities and a higher risk of developing this complication, including cancer, the use of more accurate diagnostic imaging tests, and a lower threshold for disease suspicion [ 8 ]. By contrast, time trend analyses have pointed out that mortality of acute PE may be decreasing [ 4 , 5 , 6 , 7 , 8 , 9 , 10 ].…”

Section: Introductionmentioning

confidence: 99%

“…This finding could be due to an increasing number of patients with severe comorbidities and a higher risk of developing this complication, including cancer, the use of more accurate diagnostic imaging tests, and a lower threshold for disease suspicion [ 8 ]. By contrast, time trend analyses have pointed out that mortality of acute PE may be decreasing [ 4 , 5 , 6 , 7 , 8 , 9 , 10 ]. Possible explanations include increased or earlier diagnosis, use of more effective therapies, and better adherence to guidelines [ 10 , 11 ].…”

Section: Introductionmentioning

confidence: 99%

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

Miguel‐Díez

Albaladejo-Vicente

López‐de‐Andrés

et al. 2020

JCM

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(1) Background: The aims of this study were to examine trends in the incidence, clinical characteristics, and in-hospital outcomes of patients hospitalized with pulmonary embolism in Spain and to identify factors associated with in-hospital mortality (IHM). (2) Methods: We included all patients who were hospitalized for pulmonary embolism between 2001 and 2018. Data were collected from the Spanish National Hospital Discharge Database. (3) Results: We identified 241,821 hospitalizations for pulmonary embolism during the study period. The incidence of pulmonary embolism increased from 20.49 cases per 100,000 inhabitants in the period 2001–2002 to 35.9 cases in the period 2017–2018 (p < 0.001). After controlling for possible confounders, there was a significant increase in the incidence over the study period (adjusted incidence rate ratio 1.53, 95% Confidence Interval I 1.51–1.56). The median length of hospital stay was 11 days in the period 2001–2002, decreasing to seven days in the period 2017–2018 (p < 0.001). For the total time period, the crude IHM rate was 9.51%. After multivariable adjustment, IHM decreased significantly over time. The IHM was significantly higher in women, in patients suffering from more comorbidities, and in those with a massive pulmonary embolism. (4) Conclusions: Our results revealed an increase in the incidence of pulmonary embolism hospitalizations from 2001 to 2018 in Spain, with older patients being the most affected.

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Section: Discussionsupporting

confidence: 91%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

Miguel‐Díez

Albaladejo-Vicente

López‐de‐Andrés

et al. 2020

JCM

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“…This interaction with age and sex is likely related to estrogen and pregnancy related risk factors at a young age and longer life expectancy of women at advanced ages. Vital registration data indicate that women aged 15-55 and over 80 years have an excess pulmonary embolism related mortality compared with men 20. Although increased incidence of pulmonary embolism in women among both of these age groups may be contributing to this, whether true sex and/or gender differences exist in case fatality rates remains to determined.…”

Section: Epidemiologymentioning

confidence: 99%

Pulmonary embolism: update on management and controversies

Duffett

Castellucci

Forgie

2020

BMJ

120

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Pulmonary embolism is a common and potentially fatal cardiovascular disorder that must be promptly diagnosed and treated. The diagnosis, risk assessment, and management of pulmonary embolism have evolved with a better understanding of efficient use of diagnostic and therapeutic options. The use of either clinical probability adjusted or age adjusted D-dimer interpretation has led to a reduction in diagnostic imaging to exclude pulmonary embolism. Direct oral anticoagulation therapies are safe, effective, and convenient treatments for most patients with acute venous thromboembolism, with a lower risk of bleeding than vitamin K antagonists. These oral therapeutic options have opened up opportunities for safe outpatient management of pulmonary embolism in selected patients. Recent clinical trials exploring the use of systemic thrombolysis in intermediate to high risk pulmonary embolism suggest that this therapy should be reserved for patients with evidence of hemodynamic compromise. The role of low dose systemic or catheter directed thrombolysis in other patient subgroups is uncertain. After a diagnosis of pulmonary embolism, all patients should be assessed for risk of recurrent venous thromboembolism to guide duration of anticoagulation. Patients with a venous thromboembolism associated with a strong, transient, provoking risk factor can safely discontinue anticoagulation after three months of treatment. Patients with an ongoing strong risk factor, such as cancer, or unprovoked events are at increased risk of recurrent events and should be considered for extended treatment. The use of a risk prediction score can help to identify patients with unprovoked venous thromboembolism who can benefit from extended duration therapy. Despite major advances in the management of pulmonary embolism, up to half of patients report chronic functional limitations. Such patients should be screened for chronic thromboembolic pulmonary hypertension, but only a small proportion will have this as the explanation of their symptoms. In the remaining patients, future studies are needed to understand the pathophysiology and explore interventions to improve quality of life.

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“…Perhaps as a consequence of these efforts, mortality of VTE has decreased over time. 1 Despite this success, many aspects of the optimal care for patients at risk for or diagnosed with VTE remain uncertain. One of the topics for which current evidence falls short to support any strong-level recommendation is the management of thromboses at unusual locations, such as splanchnic vein thrombosis and cerebral vein thrombosis.…”

Section: Essentialsmentioning

confidence: 99%

Trends in mortality related to pulmonary embolism in the European Region, 2000–15: analysis of vital registration data from the WHO Mortality Database

Cited by 211 publications

References 74 publications

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

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

Pulmonary embolism: update on management and controversies

Anticoagulation in splanchnic and cerebral vein thrombosis: Still groping in the dark

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