Incidence of chronic thromboembolic pulmonary Hypertension after acute pulmonary embolism in real-world practice

Abstract

Abstract Background Recently a large prospective multicentre observational cohort study demonstrated a 2-year cumulative CTEPH incidence of 2.3% after acute PE with a standardized and pre-defined follow-up plan. Thus, we sought to investigate the prevalence and incidence of CTEPH diagnosis after acute PE in real-world practice in a twelve-year observational period. Methods This study is based on nationwide ambulatory billing claims (VDA) and drug prescription (AVD) data of all residents with statutory health insured (SHI) in Germany from 2010 to 2019 (approx. 73 million in 2019). Results We identified 573,972 patients with acute PE in the German ambulatory care system between 2010 and 2019. The majority of patients were women (57.4%) and had a median age of 71 years. Prevalence of CTEPH increased during this twelve-year observational period from 0.4% in 2010 to 0.7% in 2019. Overall, a CTEPH diagnosis was made in 2556 (0.4%) patients after acute PE during a follow-up of 30 quarters (90 months). The majority of CTEPH cases (17.7%) were diagnosed in the first quarter after the index PE event. The incidence rate after the first quarter was calculated as 0.08%. The cumulative incidence after two years (8th quarter) was calculated as 0.37% and after the complete follow-up time (90 months) as 0.76% (Figure 1). Patients with CTEPH diagnosis during follow-up had considerably more often a diagnosis of acute right ventricular dysfunction at the index PE event compared to patients without CTEPH during follow-up (14.9% vs. 8.3%; ARR +6.67%). Regarding predisposing risk factors for CTEPH, especially hypothyreodism and consecutive levothyroxine application were more often present in patients with acute PE and CTEPH diagnosis during follow-up opposed to those without (18.9% vs. 16.8%; ARR +2.11%). Conclusions In conclusion, our study provides a comprehensive view of incidence of CTEPH after acute PE in real-word practice. The low rate of CTEPH incidence after acute PE indicate a limited awareness regarding CTEPH and lack of standardized follow-up for patients with acute PE in real-world practice, which may lead to a considerable under-diagnosis of CTEPH in Germany. On the basis of these data, a better implantation of existing clinical evaluation strategies for follow-up after acute PE seems indicated.Cumulative Incidence CTEPH