May 7, 2019Open Access

Temporal trends in management and outcome of pulmonary embolism: a single-centre experience

MEMatthias EbnerInterventional Cardiology KKKarl‐Patrik KresojaInterventional Cardiology KKKarsten KellerGeneral Cardiology

Structured PICO

How have temporal trends in risk-adjusted management impacted in-hospital adverse outcomes and 1-year mortality in patients with pulmonary embolism?

Population

605 patients with pulmonary embolism consecutively enrolled in a single-centre registry between 09/2008 and 08/2016, median age 70 years, 53% female.

Intervention

Contemporary management of pulmonary embolism (including NOACs, early discharge, and risk-adjusted management according to ESC guidelines)

Comparator

Historical management (earlier years of the registry, specifically 09/2008-08/2014 vs 09/2014-08/2016)

Outcome

In-hospital adverse outcomes and 1-year mortalityhard clinical

In-hospital adverse outcomes and 1-year mortality for pulmonary embolism have remained stable over an 8-year period despite shifts toward shorter hospital stays, more early discharges, and increased NOAC use.

Abstract

BACKGROUND: Real-world data on the impact of advances in risk-adjusted management on the outcome of patients with pulmonary embolism (PE) are limited. METHODS: To investigate temporal trends in treatment, in-hospital adverse outcomes and 1-year mortality, we analysed data from 605 patients median age, 70 years (IQR 56-77) years, 53% female consecutively enrolled in a single-centre registry between 09/2008 and 08/2016. RESULTS: Over the 8-year period, more patients were classified to lower risk classes according to the European Society of Cardiology (ESC) 2014 guideline algorithm while the number of high-risk patients with out-of-hospital cardiac arrest (OHCA) increased. Although patients with OHCA had an exceptionally high in-hospital mortality rate of 59.3%, the rate of PE-related in-hospital adverse outcomes (12.2%) in the overall patient cohort remained stable over time. The rate of reperfusion treatment was 9.6% and tended to increase in high-risk patients. We observed a decrease in the median duration of in-hospital stay from 10 (IQR 6-14) to 7 (IQR 4-15) days, an increase of patients discharged early from 2.1 to 12.2% and an increase in the use of non-vitamin K-dependent oral anticoagulants (NOACs) from 12.6 to 57.2% in the last 2 years (09/2014-08/2016) compared to first 6 years (09/2008-08/2014). The 1-year mortality rate (16.9%) remained stable throughout the study period. CONCLUSION: In-hospital adverse outcomes and 1-year mortality remained stable despite more patients with OHCA, shorter in-hospital stays, more patients discharged early and a more frequent NOAC use.

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