Key result
Pandemic-era acute PE admissions show unchanged mortality but link to ~13% more major bleeding.
Why the study?
Does the COVID-19 pandemic era alter in-hospital mortality, MACCE, and major bleeding in acute pulmonary embolism hospitalizations compared to the pre-pandemic era?
Cohort (n=1,069,170)
Yes
Does the COVID-19 pandemic era alter in-hospital mortality, MACCE, and major bleeding in acute pulmonary embolism hospitalizations compared to the pre-pandemic era?
Odds Ratio: 1 (95% CI 0.96–1.03)
The COVID-19 pandemic was associated with higher acuity and increased bleeding complications in acute PE hospitalizations, though adjusted in-hospital mortality remained unchanged.
Background The COVID-19 pandemic disrupted healthcare systems, potentially altering acute pulmonary embolism (PE) outcomes. This study evaluates pandemic-era shifts in PE mortality, admissions, and resource utilization across two distinct periods: pre-pandemic (2016-2019) and pandemic-era (2020-2021). Methods Retrospective cohort analysis of 1,069,170 acute PE hospitalizations (2016–2021) from the U.S. National Inpatient Sample. Primary outcomes included in-hospital major adverse cardiovascular/cerebrovascular events (MACCE), mortality, and major bleeding. Secondary outcomes assessed admission rates, length of stay (LOS), and costs. Multivariable logistic regression adjusted for age, sex, comorbidities, and hospital characteristics. Results Annual acute PE admissions declined from 55.9/100,000 population (2019) to 50.2/100,000 (2021). In-hospital mortality peaked at 3.4% in 2020. Pandemic-era (2020–2021) patients demonstrated higher acuity: cardiac arrest (2.0% vs. 1.6%), saddle PE (11.0% vs. 8.7%), high-risk PE (4.6% vs. 4.0%), cardiogenic shock (1.6% vs. 1.4%), acute cor pulmonale (11.6% vs. 7.7%), longer mean LOS (4.4 vs 4.3 days) and total charge ($57,709 vs. $48,436; all p<0.001). Adjusted analyses revealed pandemic-era reductions in catheter-directed thrombolysis (aOR 0.89, 95% CI 0.87 – 0.91) but increased catheter-directed embolectomy (aOR 4.95, 95% CI 4.81 – 5.10). Major bleeding (aOR 1.13, 95% CI 1.10 – 1.16) and intracranial hemorrhage (aOR 1.27, 95% CI 1.20 – 1.34) rose significantly (p<0.001), while mortality remained unchanged (aOR 1.0, 95% CI 0.96–1.03). Conclusion The pandemic correlated with reduced acute PE admissions, increased disease severity, and shifts in procedural management. While mortality rates stabilized after adjustment, complications escalated, highlighting resource strain and potential care delays. These findings underscore the need for adaptive care protocols during public health crises.
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Gatuz et al. (2025) conducted a cohort in Acute pulmonary embolism (n=1,069,170). Pandemic-era (2020-2021) vs. Pre-pandemic (2016-2019) was evaluated on In-hospital mortality (aOR 1.0, 95% CI 0.96-1.03). The COVID-19 pandemic era was associated with unchanged adjusted mortality (aOR 1.0; 95% CI 0.96-1.03) but increased major bleeding (aOR 1.13; 95% CI 1.10-1.16) in acute pulmonary embolism admissions.
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