F-28 | Impact of the COVID-19 pandemic on the management of patients with acute pulmonary embolism

There is a paucity of data on the impact of COVID-19 pandemic on the management and outcomes of acute pulmonary embolism (PE). We identified hospitalizations with a primary diagnosis of acute PE from the Vizient®Clinical Data Base with permission of Vizient, Inc. (All rights reserved)between 2016-2022. High-risk PE was defined as cardiogenic shock and/or requirement for vasopressor. We examined the trends of advanced therapy utilization prior to the COVID pandemic (2016-Q1 2020), during (Q2 2020-2021), and after (2022). Multivariable logistic regression adjusting for patient, disease, and hospital characteristics was conducted to compare the incidence of in-hospital mortality, intracranial hemorrhage (ICH), and non-ICH major bleeding. There were 561,155 primary hospitalizations with acute PE, of which 17,833 (3.1%) had high-risk PE. In the cohort from Q2 2020-2022, 14.7% were COVID positive. In the high-risk PE cohort, there was a decrease in the use of systemic thrombolysis (ST) (8.7% vs 7.8%), catheter-directed thrombolysis (CDT) (5.5% vs 1.4%), but an increase in catheter-directed embolectomy (CDE) (4.5% vs 9.6%). Among those with high-risk PE from Q2 2020-2022, COVID positive patients were less likely to undergo CDT (1.1% vs 2.1%) or CDE (4.0% vs 9.0%), but more likely to receive ST (11.5% vs 7.6%). For the overall cohort, the rate of in-hospital mortality increased during the study period (7.4% vs 9.0%) and peaked during the pandemic (9.7%); adjusted odds ratio [aOR] 1.07, 95% confidence interval [CI] (1.04-1.10), but there was no difference in the high-risk group (41.4% vs 39.7%). On multivariable analysis, COVID infection was independently associated with higher in-hospital mortality (2.39, 95% CI 1.62-2.20), and major bleeding (aOR 1.10, 95% CI 1.07-1.14), but lower incidence of ICH (aOR 0.69, 95% CI 0.62-0.76). In this nationwide observational analysis of high-risk PE hospitalizations, there has been a decline in the use of ST and CDT, but an increase in the use of CDE. During the pandemic, patients with COVID-associated PE were more likely treated with ST. COVID-19 infection was independently associated with higher incidence of mortality and non-ICH major bleeding, but lower rates of ICH.