Abstract 13807: Sex Differences in Patients Characteristics, Risk Factors, and Symptomatology in Older Adults With Pulmonary Embolism: Findings From the SERIOUS-PE Study

Abstract

Background: Biological sex is linked with pulmonary embolism (PE) disease presentation in young patients, such as the risk incurred by pregnancy. Whether sex differences exist in PE presentation, co-morbidities, risk factors, and symptomatology in older adults, the age group in which most of these events occur, remains unknown. Methods: We identified older adults (aged ≥65 years) with PE in a large international PE registry that is replete with granular clinical information about clinical characteristics and PE symptoms (RIETE registry, 2001-2021). To provide national data from the USA, we assessed sex differences in risk factors and clinical characteristics of US Medicare beneficiaries with PE (2001-2019). Results: The majority of older adults with PE in RIETE (19,294/ 33,462, 57.7%) and in Medicare database (551,492/ 948,823, 58.7%) were women (Panel A). Compared with men, women with PE less frequently had atherosclerotic diseases, obstructive lung disease, cancer, or unprovoked PE, but more frequently had a varicose veins, depression, prolonged immobility, or history of hormonal therapy (P<0.001 for all, Panel B). Compared with men, women less often presented with chest pain (37.3% vs 40.6%) or with hemoptysis (2.4% vs 5.6%), but more often presented with dyspnea (84.6% vs 80.9%) (P<0.001 for all). The proportions of patients with syncope (16.4% vs 15.9%) and patients with simplified Pulmonary Embolism Severity Index >0 (76.3% vs 75.0%) were comparable. Conclusions: In routine practice, elderly women constitute the largest proportion of patients with PE. Sex differences exist in risk factors and clinical presentation of older adults with PE, with cancer and cardiovascular disease being more common in men; and transient provoking factors such as immobility or hormone therapy being more common in women. Whether such differences correlate with disparities in treatment, or differences in short- or long-term clinical outcomes warrant further investigation.