Geriatric characteristics and outcomes of older patients diagnosed with acute pulmonary embolism in the emergency department

Introduction Knowledge on characteristics and outcomes of older patients with pulmonary embolism (PE) fuels decision making on PE management, but data are scarce. We aimed to describe geriatric characteristics and outcomes of older patients diagnosed with PE in the Emergency Department. Methods We used two ED-cohorts from the Leiden University Medical Center in the Netherlands: 229 patients (≥70 years) diagnosed with PE in the ED between 2015 and 2022, and 751 control patients (≥70 years) who visited the ED in 2014 for any indication. We compared baseline cognition and physical functioning, and outcomes including mortality and hospitalization between the two cohorts. Results At ED presentation the median age was 76 years (IQR=72-81) for PE patients and 78 years (IQR=74-83) for control patients (p<0.001). PE patients had similar cognitive impairment (23% vs 25%, p=0.84) and functional impairment (37% vs 40%, p=0.67) compared to the control patients. PE patients were more often hospitalized (OR: 4.1; 95%CI: 2.9-5.7), and had a higher 7 days mortality (HR: 3.2; 95%CI: 1.5-6.9), 3 months mortality (HR: 1.7; 95%CI: 1.1-2.6) and 12 months mortality (HR: 1.6; 95%CI: 1.2-2.2). The 56 of 229 (24%) PE patients with an active cancer diagnosis had a fourfold higher 3 months mortality risk compared to PE patients without cancer. Conclusion Older PE patients and general older patients are comparable in terms of cognitive and physical functioning at ED presentation. PE is associated with higher mortality among other ED presentations, particularly in patients with underlying cancer.