Key result
Age ≥80 linked to ~51% higher in-hospital mortality in PE with cardiogenic shock.
Why the study?
Pulmonary embolism complicated by cardiogenic shock carries significant morbidity and mortality, and as the population ages, understanding age-related differences in outcomes and management is needed to optimize care in this high-risk cohort.
Does elderly age (≥80 years) affect in-hospital mortality and utilization of advanced therapies compared with younger age (18–79 years) in patients hospitalized with pulmonary embolism complicated by cardiogenic shock?
Observational (n=55,420)
Yes
Does elderly age (≥80 years) affect in-hospital mortality and utilization of advanced therapies compared with younger age (18–79 years) in patients hospitalized with pulmonary embolism complicated by cardiogenic shock?
Answers are grounded in this paper and cite their sources.
Elderly patients (≥80 years) with pulmonary embolism complicated by cardiogenic shock experience significantly higher in-hospital mortality (47% vs 37%) while receiving fewer advanced mechanical and circulatory support therapies compared to younger patients.
Background Pulmonary embolism (PE) complicated by cardiogenic shock (CS) is associated with significant morbidity and mortality. As the population ages, understanding age-related differences in outcomes and management is critical to optimizing care in this high-risk cohort. Methods Using the National Inpatient Sample database, adults hospitalized with PE and CS, stratifying them into elderly (≥80 years) and younger (18–79 years) groups in the U.S. between 2016-2022. Multivariable logistic regression was performed to evaluate age-based differences in in-hospital outcomes and utilization of advanced therapies. Results Among 55,420 patients with PE and CS, 7,780 (14%) were elderly. In-hospital mortality was significantly higher in elderly patients compared with younger patients (47% vs 37%; adjusted odds ratio [aOR] 1.51, 95% CI 1.43–1.60; p<0.0001). Despite higher mortality, elderly patients were less likely to receive advanced interventions, including mechanical ventilation (30% vs 43%; aOR 0.68, 95% CI 0.64–0.72), extracorporeal membrane oxygenation ECMO (0.2% vs 6%; aOR 0.06, 95% CI 0.04–0.09), Impella support (1% vs 3%; aOR 0.44, 95% CI 0.35–0.56), and intra-aortic balloon pump IABP (3% vs 5%; aOR 0.54, 95% CI 0.46–0.63) (all p<0.0001). Elderly patients also had higher odds of heart block (15% vs. 10%; aOR 1.49; 95% CI: 1.37 - 1.61), permanent pacemaker implantation (2% vs. 1%; aOR 2.28; 95% CI: 1.80 - 2.90) and in-hospital myocardial infarction (29% vs. 23%; aOR 1.32; 95% CI: 1.25 - 1.41); all p<0.0001. Conclusion Elderly patients with PE complicated by CS experience significantly higher in-hospital mortality while receiving fewer advanced mechanical and circulatory support therapies. These findings suggest potential management disparities and underscore the importance of individualized, age-conscious decision-making that balances clinical risk, frailty, and patient preferences to improve outcomes in this vulnerable population.
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Jahan et al. (2026) conducted an observational in Pulmonary embolism complicated by cardiogenic shock (n=55,420). Elderly age (≥80 years) vs. Younger age (18-79 years) was evaluated on In-hospital mortality (aOR 1.51, 95% CI 1.43-1.60, p=<0.0001). Elderly age (≥80 vs 18-79 years) in PE with cardiogenic shock was associated with higher in-hospital mortality (47% vs 37%; aOR 1.51, 95% CI 1.43-1.60; p<0.0001) and lower advanced therapy use.
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