Abstract
Pulmonary embolism (PE) mortality has decreased in the last decades but acute PE is still associated with significant fatality. Specific information on fatal PE patients could guide how to efficiently improve PE management but to date this information has been scarce. All the individuals with PE defined as an immediate or underlying cause of death were collected from the death certificate archive of the Hospital District of Helsinki and Uusimaa, Finland, including approximately 1.7 million inhabitants (2015–2018). Crude and age-adjusted mortality rates and proportional mortality were calculated, and the distribution of comorbidities at death and death location (in-hospital, palliative care, or out-of-hospital) was analyzed. In total, 451 individuals with fatal PE were identified (238 females) with a mean age of 72 years (SD 13.5 year). Most of the fatal PEs (n = 264, 54.5%) occurred out-of-hospital and surprisingly, 70 (26.5%) of these individuals s had a history of mental illness or substance abuse. The out-of-hospital resuscitation was attempted in 108 (40.1%) individuals but only 7 (6.5%) received thrombolysis during resuscitation. Fatal PE occurred during hospitalization in 98 individuals and in 54 (55.1%), the diagnosis was only made postmortem. Majority of the fatal PEs occurred out-of-hospital and were diagnosed postmortem whereas only small proportion of deaths occurred to in-hospital PE patients. The earlier diagnosis of PE, which may be accomplished by raising the general awareness of PE, is necessary to prevent these sudden deaths of whom many occurred to individuals with history of mental illnesses or substance abuse.
Highlights
Pulmonary embolism is the third most common cause of cardiovascular mortality and its incidence has increased along with the aging of the population in the developed countries [1, 2]
All the individuals from the HUS district with fatal Pulmonary embolism (PE) event (individuals with 10th revision of International Classification of Diseases (ICD code) I26.0 or I26.9 for PE as their immediate or underlying cause of death) were identified from death certificate archive, which is produced by the Statistics Finland [14]
This highlights the need for earlier diagnosis of PE and the recognition of PE as the etiology of out-of-hospital cardiac arrest whereas further advances in the care of hospitalized PE patients may have less impact on PE mortality
Summary
Pulmonary embolism is the third most common cause of cardiovascular mortality and its incidence has increased along with the aging of the population in the developed countries [1, 2]. Studies have reported a decrease in PE mortality in the last decades both in the European region and in North America [3, 4]. An alarming rebound increase was observed among young and middle-aged adults in the USA after 2006. Further advances in the management of PE are needed to continue the positive trend and better understanding of PE fatalities is warranted
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