A66-12 Assessing the Impact of Substance Use Disorder on Pert Activation and Outcomes in Pulmonary Embolism

Abstract Rationale The rationale for this study is to evaluate the impact of substance use disorder (SUD) on outcomes in patients with pulmonary embolism (PE), an area that remains underexplored. Although SUD is associated with worse cardiovascular outcome, its effect on PE severity and outcomes is not well defined. Pulmonary Embolism Response Teams (PERTs) have demonstrated improved coordination and more equitable care in PE management. By analyzing outcomes at a hospital equipped with a PERT, this study aims to assess whether disparities persist between patients with and without SUD. Methods This is a retrospective observational study of patients with acute PE between April 2023 and August 2025 at a large urban safety-net hospital equipped with a PERT. Patient data were obtained through electronic health record review. Variables collected included demographics, housing status, substance use history (this included alcohol use, methamphetamine use, cocaine use, multiple) and PE severity indices. The primary outcome was PERT activation. Secondary variables included PESI score, RV strain, and in-hospital outcomes. Logistic regression was performed to assess the association between SUD and PERT activation, adjusting for age, gender, RV strain, and length of stay. Statistical analyses were conducted using Stata. Results A total of 140 patients with confirmed pulmonary embolism were included, of whom 60 (43%) had a documented history of SUD. Patients with SUD were younger (mean age 55 vs. 64 years) and more likely to be unhoused (46% vs. 11%) and current or former tobacco users (82% vs. 45%) compared to those without SUD. The mean PESI score was lower among the SUD group (97.9 vs. 113.6), and the proportion with massive or submassive PE was slightly higher (24% vs. 18%). PERT activation occurred less frequently in the SUD group (30% vs. 40%). In logistic regression, after adjusting for age, gender, LOS, and RV strain, substance use was associated with lower odds of PERT activation (OR 0.45, p = 0.079). Conclusions In our cohort, patients with SUD were less likely to have PERT activation compared to those without SUD, despite similar in-hospital mortality (7% vs. 4%). Although patients with SUD had a lower mean PESI score, likely reflecting their younger average age, their clinical outcomes were not more favorable. This suggests that traditional risk stratification tools may underestimate illness severity in this population. Given these findings, clinicians should maintain a lower threshold for PERT activation in patients with SUD to ensure equitable access to advanced PE management strategies. This abstract is funded by: None