Key result
African American race was not associated with a significant difference in in-hospital mortality compared to Caucasian race in patients with acute pulmonary embolism (7.1% vs. 7.9%, p=0.71).
Why the study?
Despite socioeconomic disparities, no clinical presentation factors explained the higher mortality in African Americans with pulmonary embolism, prompting an investigation into associated co-morbidities and echocardiographic characteristics.
Does African American race compared to Caucasian race affect in-hospital mortality, length of stay, and bleeding in patients with acute pulmonary embolism?
Cross-Sectional (n=646)
No
Does African American race compared to Caucasian race affect in-hospital mortality, length of stay, and bleeding in patients with acute pulmonary embolism?
Absolute Event Rate: 7.1% vs 7.9%
p-value: p=0.71
While overall in-hospital mortality did not differ by race in acute pulmonary embolism, African Americans exhibited more right ventricular strain and had higher mortality when receiving advanced therapies.
Higher PE mortality in African Americans unexplained by presentation; leaves open comorbidities and echocardiographic factors for prospective validation.
Background Despite socioeconomic disparities, no association between clinical presentation and poor outcomes explains a higher mortality in African Americans with pulmonary embolism (PE). The objective is to identify the co-morbidities and echocardiographic characteristics associated with increased mortality in African American patients. Methods This is a cross-sectional study of Caucasian or African American patients with PE diagnosed between October 2015 and December 2017 at University of Maryland Medical Center. The outcomes were in-hospital death, length of stay, and bleeding. Results There were 303 African Americans and 343 Caucasians. Caucasians were older ( p = 0.007), males ( p = 0.01) with history of coronary artery revascularization (CABG ( p = 0.001), coronary stents ( p = 0.001)), trauma ( p = 0.007), and/or recent surgeries ( p = 0.0001). African Americans exhibited higher rates of diabetes ( p = 0.01), chronic kidney disease ( p = 0.0005), and smoking ( p = 0.04). Severity of PE was similar between groups and there was no difference in clot burden size. African Americans had more right ventricular strain on Computer Tomography ( p = 0.001) and echocardiogram ( p = 0.004); also, underfilled left ventricles ( p = 0.02) and higher right ventricular systolic pressures ( p = 0.001). There was no difference in hospital mortality (7.1% vs. 7.9%, p = 0.71), length of stay (13.1 ± 16.7 vs 12.8 ± 14.9, p = 0.80) and bleeding (9.0% vs.8.3%. p = 0.72). Mortality was higher in African Americans who received advanced therapies (3.8% vs. 18.8%, p = 0.02). The risk of death increased with age (OR 1.04; 95%CI 1.020–1.073) and with advanced therapies (OR 2.43; 95%CI 1.029–5.769). Conclusions Differences in co-morbidities, radiologic findings, and echocardiographic characteristics that may contribute to higher mortality in African American patients, specifically those receiving advanced therapies.
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Cires-Drouet et al. (2022) conducted a cross-sectional in acute pulmonary embolism (n=646). African American race vs. Caucasian race was evaluated on in-hospital mortality (p=0.71). African American race was not associated with a significant difference in in-hospital mortality compared to Caucasian race in patients with acute pulmonary embolism (7.1% vs. 7.9%, p=0.71).
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