Trends in the Management and Outcomes of Acute Pulmonary Embolism

Jiménez, David; Miguel-Díez, Javier de; Guijarro, Ricardo; Trujillo‐Santos, Javier; Otero, Remedios; Barba, Raquel; Muriel, Alfonso; Meyer, Guy; Yusen, Roger D.; Monreal, Manuel; Investigators, Riete

doi:10.1016/j.jacc.2015.10.060

Cited by 306 publications

(193 citation statements)

References 26 publications

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“…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]. In our study, the hospitalization length decreased from 13 days to 7 days.…”

Section: Discussionsupporting

confidence: 46%

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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Section: Discussionsupporting

confidence: 46%

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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“…Acute pulmonary embolism (PE) is a serious thromboembolic condition accounting for thousands of hospitalizations and associated with high short‐term mortality rates 1, 2. Some studies suggest that transthoracic echocardiography (TTE) could help in early risk stratification of patients with acute PE.…”

Section: Introductionmentioning

confidence: 99%

Early Use of Echocardiography in Patients With Acute Pulmonary Embolism: Findings From the RIETE Registry

Bikdeli

Lobo

Jiménez

et al. 2018

JAHA

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BackgroundTransthoracic echocardiography (TTE) is often considered for risk stratification of patients with acute pulmonary embolism (PE). We sought to determine the contemporary utilization of early TTE (within 72 hours of PE diagnosis) and explored the association between TTE findings and PE‐related mortality.Methods and ResultsData from the RIETE (Registro Informatizado Enfermedad TromboEmbolica) registry, a multicenter registry of consecutive patients with acute PE, were used (2001–July 2017). We used a generalized linear mixed model to determine predictors of early TTE performance. Moreover, the association between 3 TTE variables (right atrial enlargement, right ventricular hypokinesis, and presence of right heart thrombi) and 30‐day PE‐related mortality was assessed in generalized linear mixed models adjusted for PE severity index, and other comorbidities. Among 35 935 enrollees with acute PE, 15 375 (42.8%) underwent early TTE. There was an increase in early TTE utilization rate over time (P<0.001 for trend). Younger age, female sex, enrollment in countries other than Spain, history of coronary disease, heart failure, atrial fibrillation, tachycardia, and hypotension were the main predictors of early TTE (P<0.01 for all). In multivariable analyses, right atrial enlargement (adjusted odds ratio: 3.74; 95% confidence interval, 2.10–6.66), right ventricular hypokinesis (adjusted odds ratio: 3.11, 95% confidence interval: 1.85–5.21) and right heart thrombi (adjusted odds ratio: 4.39, 95% confidence interval, 1.99–9.71) were associated with increased odds for PE‐related mortality.ConclusionsEarly TTE is commonly performed for acute PE and utilization rates have increased over time. Right atrial enlargement, right ventricular hypokinesis, and right heart thrombi are predictive of worse outcomes.Clinical Trial Registration URL: http://www.clinicaltrials.gov. Unique identifier: NCT02832245.

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“…Immobilized patients were defined as non‐surgical patients who had been immobilized (ie, total bed rest with bathroom privileges) for ≥4 days in the 2‐month period prior to VTE 12. Surgical patients were defined as those who underwent a surgical intervention in the 2 months prior to VTE 11. Active cancer was defined as newly diagnosed cancer, metastatic cancer, or cancer that was being treated (ie, surgery, chemotherapy, radiotherapy, support therapy) 10.…”

Section: Methodsmentioning

confidence: 99%

“…RIETE ( R egistro I nformatizado E nfermedad T rombo E mbólica) is a multicenter, ongoing, international (Spain, Belgium, Brazil, Canada, Czech Republic, Ecuador, France, Israel, Italy, Latvia, Republic of Macedonia, Switzerland, and the United States enroll patients) registry of consecutive patients with symptomatic, objectively confirmed, acute VTE (ClinicalTrials.gov identifier: NCT02832245) 9, 10, 11, 12, 13. Since its inception in 2001, the aim of RIETE is to record data including the clinical characteristics, treatment patterns, and outcomes in patients diagnosed with VTE.…”

Section: Introductionmentioning

confidence: 99%

Clinical outcomes during anticoagulant therapy in fragile patients with venous thromboembolism

Moustafa

Giorgi‐Pierfranceschi²,

Micco

et al. 2017

Research and Practice in Thrombosis and Haemostasis

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Essentials Recent randomized trials suggested fewer bleeding events in fragile patients with VTE receiving DOACs.The frequency, clinical characteristics and outcome of these patients have not been reported in real life.Fragile patients with VTE had a higher risk for major bleeding or death and a lower risk for recurrences than non‐fragile. BackgroundSubgroup analyses from randomized trials suggested favorable results for the direct oral anticoagulants in fragile patients with venous thromboembolism (VTE). The frequency and natural history of fragile patients with VTE have not been studied yet.ObjectivesTo compare the clinical characteristics, treatment and outcomes during the first 3 months of anticoagulation in fragile vs non‐fragile patients with VTE.MethodsRetrospective study using consecutive patients enrolled in the RIETE (Registro Informatizado Enfermedad TromboEmbolica) registry. Fragile patients were defined as those having age ≥75 years, creatinine clearance (CrCl) levels ≤50 mL/min, and/or body weight ≤50 kg.ResultsFrom January 2013 to October 2016, 15 079 patients were recruited. Of these, 6260 (42%) were fragile: 37% were aged ≥75 years, 20% had CrCl levels ≤50 mL/min, and 3.6% weighed ≤50 kg. During the first 3 months of anticoagulant therapy, fragile patients had a lower risk of VTE recurrences (0.78% vs 1.4%; adjusted odds ratio [OR]: 0.52; 95% confidence intervals [CI]: 0.37‐0.74) and a higher risk of major bleeding (2.6% vs 1.4%; adjusted OR: 1.41; 95% CI: 1.10‐1.80), gastrointestinal bleeding (0.86% vs 0.35%; adjusted OR: 1.84; 95% CI: 1.16‐2.92), haematoma (0.51% vs 0.07%; adjusted OR: 5.05; 95% CI: 2.05‐12.4), all‐cause death (9.2% vs 3.5%; adjusted OR: 2.02; 95% CI: 1.75‐2.33), or fatal PE (0.85% vs 0.35%; adjusted OR: 1.77; 95% CI: 1.10‐2.85) than the non‐fragile.ConclusionsIn real life, 42% of VTE patients were fragile. During anticoagulation, they had fewer VTE recurrences and more major bleeding events than the non‐fragile.

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Trends in the Management and Outcomes of Acute Pulmonary Embolism

Abstract: In a large international registry of patients with PE, improvements in length of stay and changes in the initial treatment were accompanied by a reduction in short-term all-cause and PE-specific mortality.

Cited by 306 publications

References 26 publications

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

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

Early Use of Echocardiography in Patients With Acute Pulmonary Embolism: Findings From the RIETE Registry

Clinical outcomes during anticoagulant therapy in fragile patients with venous thromboembolism

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