F-43 | In-Hospital Outcomes of Pulmonary Embolism Treated with Catheter Interventions: A Comparison in Patients With and Without Heart Failure using National Inpatient Sample

Some studies indicate that patients with heart failure (HF) who develop acute pulmonary embolism (PE) experience higher mortality rates. Our objective was to examine whether catheter-directed interventions, such as thrombectomy or thrombolysis for acute PE, result in worse outcomes in patients with HF. This study utilized the 2016-2020 National Inpatient Sample. All patients admitted for pulmonary embolism who were undergoing catheter based thrombectomy/thrombolysis were identified using ICD-10 codes. These patients were divided into two cohorts based on the presence of HF. Multivariate linear/logistic regression analysis was conducted to estimate the probability of outcomes. Primary outcomes were inpatient mortality. Secondary outcomes were cardiogenic shock, length of stay (LOS), total hospital charge (THC) and major bleeding events (requiring massive blood transfusion or intracranial hemorrhage). Stata/SE software was used to perform the analysis. P-values <0. 05 were considered statistically significant. A total of 145, 550 patients met the survey parameters. Among them, 14. 2% had HF. While there was a trend towards higher mortality in patients undergoing intervention and HF compared to the other cohort, it was statistically non-significant (adjusted OR 1. 46, 95% CI 0. 89 - 1. 19, P=0. 69). No statistically significant effect of HF on LOS was observed. The HF cohort experienced a mean decrease in their THC by 10, 483 (P=0. 00). HF patients had higher odds of developing cardiogenic shock (aOR 1. 54, 95% CI 1. 21 - 1. 94, P=0. 00) but no significantly higher odds of major bleeding events. Interestingly, females had higher odds of death (aOR 1. 41, P=0. 00), major bleeding events (aOR 1. 63, P=0. 00), and longer LOS (P=0. 00). Patients admitted for PE requiring advanced interventions should not be excluded based solely on the presence of HF. While higher odds of cardiogenic shock and a non-significant trend toward increased mortality were observed in HF patients undergoing advanced interventions for PE, these patients had lower hospital costs and no significant difference in LOS. It remains uncertain whether stratification of heart failure based on ejection fraction will alter these outcomes.