Key result
In-hospital mortality for high-risk PE drops from 51% to ~44% over a decade in Japan.
Why the study?
The impact of major changes in pulmonary embolism treatment, including limited systemic thrombolysis and introduction of direct oral anticoagulants, was not well documented.
Observational (n=88,966)
Yes
Over a 10-year period in Japan, in-hospital mortality for both high-risk and non-high-risk pulmonary embolism significantly decreased alongside changes in treatment practices such as increased DOAC and ECMO use and decreased systemic thrombolysis.
Answers are grounded in this paper and cite their sources.
Trends in PE care coincided with lower mortality; observational data leaves causal effects and practice changes open for prospective confirmation.
Background The impact of major changes in the treatment practice of pulmonary embolism (PE), such as limited indications for systemic thrombolysis and the introduction of direct oral anticoagulants, is not well documented. This study aimed to describe annual trends in the treatment patterns and outcomes in patients with PE. Methods and Results Using the Japanese Diagnosis Procedure Combination inpatient database from April 2010 to March 2021, we identified hospitalized patients with PE. Patients with high‐risk PE were defined as those admitted for out‐of‐hospital cardiac arrest or who received cardiopulmonary resuscitation, extracorporeal membrane oxygenation, vasopressors, or invasive mechanical ventilation on the day of admission. The remaining patients were defined as patients with non–high‐risk PE. The patient characteristics and outcomes were reported with fiscal year trend analyses. Of 88 966 eligible patients, 8116 (9.1%) had high‐risk PE, and the remaining 80 850 (90.9%) had non–high‐risk PE. Between 2010 and 2020, in patients with high‐risk PE, the annual proportion of extracorporeal membrane oxygenation use significantly increased from 11.0% to 21.3%, whereas that of thrombolysis use significantly decreased from 22.5% to 15.5% ( P for trend <0.001 for both). In‐hospital mortality significantly decreased from 51.0% to 43.7% ( P for trend=0.04). In patients with non–high‐risk PE, the annual proportion of direct oral anticoagulant use increased from 0.0% to 38.3%, whereas that of thrombolysis use significantly decreased from 13.7% to 3.4% ( P for trend <0.001 for both). In‐hospital mortality significantly decreased from 7.9% to 5.4% ( P for trend <0.001). Conclusions Substantial changes in the PE practice and outcomes occurred in patients with high‐risk and non–high‐risk PE.
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Nishimoto et al. (2023) conducted an observational in Pulmonary embolism (n=88,966). Time period (2010 to 2020) vs. 2010 was evaluated on In-hospital mortality in high-risk PE (p=0.04). Between 2010 and 2020, in-hospital mortality for pulmonary embolism in Japan significantly decreased from 51.0% to 43.7% in high-risk patients and from 7.9% to 5.4% in non-high-risk patients.
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