Trends in the incidence and treatment of pulmonary embolism in Poland (2018–2023): Insights from public healthcare data

There are limited epidemiological data on the incidence and prognosis of acute pulmonary embolism (PE) in Poland. We assessed the incidence of PE, its therapies and all-cause mortality in Poland in years 2018-2023 using administrative national health care database. The number all PE hospitalizations ranged from 16 641 cases in 2020 up to 25 363 patients in 2021. Recurrent PE accounted for 5.9% of all PE cases. The mean annual hospitalization rate for PE, used as an estimate of PE incidence, was 56 per 100 000 population, increasing 49/100 000 in 2018, to 62/100 000 in 2023 with trend to statistical significance (P = 0.059). Average in-hospital mortality rate during 6-year period was 13% (SD 0.97), and was the highest during COVID-19 pandemic years exceeding 14% (P <0.01). Cumulative all-cause mortality (in years 2018-2023) at 12 months averaged 31.1% (SD 1.55%). Women presented higher in hospital and one-year mortality when compared to men (P <0.001). In patients free of malignancy and COVID-19 one year mortality was 23.3%, while when neoplasm coexisted it exceeded 50%. Majority of patients were anticoagulated only. Thrombolysis or surgical embolectomy were used infrequently (<1% of patients), however we observed a progressive increase of percutaneous therapies. Direct oral anticoagulants after the discharge were prescribed in 73.1% of patients. However, 3.8% of patients discharged did not purchase recommended prescription. This non-adherent subgroup showed at 1 year was 2,6 -fold higher mortality risk comparing to subjects adherent to anticoagulation (HR, 2.59; 95% CI, 2.441-2.750; P <0.001). Lower estimated annual PE incidence in Poland of 60/100 000 persons when compared to recent European data suggesting suboptimal PE diagnosis and high all cause in hospital and one year mortality rates necessitate improvement of PE diagnosis and management. Moreover, our data showed that women with PE may have worse prognosis than men and that non-adherence to anticoagulation significantly reduces one year post discharge survival.