Admissions For Pulmonary Embolism Research Articles

Trends in home treatment and early discharge of patients with low-risk pulmonary embolism

Abstract Background A strategy of ambulatory treatment or early discharge (≤ 48 hours) of patients with acute low-risk pulmonary embolism (PE) has been adopted by the most recent guideline recommendations. However, the adoption of such a change of paradigm in PE care in the ‘real-world’ clinical setting, outside the concept of prospective cohort (management) studies, remains unknown. Aims To determine the proportion of patients with PE who fulfill eligibility criteria for home treatment or early discharge, to investigate in how many of them such a management strategy is actually followed, and to discover differences in early complications between early or later discharge among low-risk patients. Methods We used two nationwide databases, the US Nationwide Emergency Department Sample (NEDS) and Nationwide Readmission Database (NRD), to identify patients with low-risk PE (absence of the following at presentation: haemodynamic instability, cor pulmonale, tachycardia, dyspnea, hypothermia, altered mental status, and fulfilment of the Hestia critieria). We investigated the proportion of patients that were discharged entirely at home, or discharged early (hospital stay £ 2 days) and their association with predictor variables. We also studied the 90-day occurrence of venous thromboembolism recurrence and major bleeding. Results From 2016 to 2020, there were 2,099,390 emergency department visits for PE (NEDS Database), with 641,621 (30.6%) classified as low-risk. Home treatment was documented in 20.3% of all cases, with 31.5% of low-risk PE cases being treated at home and an increasing trend over time (Figure 1A). Factors associated with home treatment for low-risk PE included younger age, female sex, and absence of comorbidities; home treatment was more frequent at university hospitals, non-metropolitan hospitals, and those with higher emergency department volumes (Figure 2A). In the NRD Database, there were 1,950,708 PE hospitalizations during the same period with 481,321 classified as low-risk (24.7%). An early discharge strategy was followed in 22.6% of all cases, increasing to 45.9% for low-risk PE admissions, with a rising trend observed from 2016 (Figure 1B). Factors associated with early discharge for low-risk PE included younger age, male sex, and absence of comorbidities; here, university hospitals and metropolitan hospitals were less likely to implement early discharge (Figure 2B). The 90-day incidence of VTE recurrence among low-risk patients was lower with early discharge (1.3% vs. 1.8%, p<0.001), as was major bleeding (1.5% vs. 2.8%, p<0.001). Conclusion Our results reveal an increasing implementation of early discharge and home treatment for low-risk PE across recent years. Factors influencing these strategies are related to demographics and hospital type. Early discharge was associated with favourable outcomes in the real-world setting, thus supporting the results of previously performed prospective cohort studies and randomized trials.Figure 1Figure 2

Trends in Acute Pulmonary Embolism Admissions and Mortality Across Metropolitan, Regional and Remote NSW from 2001–2021: A Retrospective Statewide Population-Linkage Cohort Study

Trends in Acute Pulmonary Embolism Admissions and Mortality Across Metropolitan, Regional and Remote NSW from 2001–2021: A Retrospective Statewide Population-Linkage Cohort Study

Association of Cannabis Use Disorder With Hospitalizations for Pulmonary Embolism and Subsequent in-Hospital Mortality in Young Adults: A Contemporary Nationwide Analysis.

With the increase in popularity of cannabis and its use and the lack of large-scale data on cannabis use and venous thromboembolism and pulmonary embolism (PE), we used a nationally representative cohort of young adults (aged 18-44 years) to compare the odds of admissions and in-hospital mortality of PE with and without cannabis use disorder (CUD). Identified patients with PE using the National Inpatient Sample (2018) were compared for baseline, comorbidities, and outcomes. Multivariable regression analysis, adjusted for covariates, was used to compare the odds of PE in young patients with CUD (CUD+) versus those without (CUD-) and those with prior venous thromboembolism. Propensity score-matched analysis (1:6) was also performed to assess in-hospital outcomes. A total of 61 965 (0.7%) of 8 438 858 young adult admissions in 2018 were PE related, of which 1705 (0.6%) had CUD+. On both unadjusted (odds ratio, 0.80 [95% CI, 0.71-0.90]; P<0.001) and adjusted regression analyses, the CUD+ cohort had a lower risk of PE admission. The CUD+ cohort had fewer routine discharges (58.3% versus 68.3%) and higher transfers to short-term (7.9% versus 4.8%) and nursing/intermediate care (12.6% versus 9.5%) (P<0.001). The PE-CUD+ cohort of in-hospital mortality did not differ from the CUD- cohort. Propensity score-matched (1:6) analysis revealed comparable mortality odds with higher median hospital stay and cost in the CUD+ cohort. Young adults with CUD demonstrated lower odds of PE hospitalizations without any association with subsequent in-hospital mortality. The median hospital stay of the CUD+ cohort was longer, they were often transferred to other facilities, and they had a higher cost.

In-hospital outcomes of acute pulmonary embolism admissions in individuals with genitourinary cancers: Insights from a national population study in the United States.

In-hospital outcomes of acute pulmonary embolism admissions in individuals with genitourinary cancers: Insights from a national population study in the United States.

Unraveling the Link: Cannabis Use Disorder and Pulmonary Embolism-Related Hospital Outcomes in Female Breast Cancer Survivors

Background: The use of cannabis in cancer patients has gained significant attention due to its analgesic properties, which help alleviate cancer-related pain. Studies have also shown the interference of cannabis with the coagulation system. We aimed to study the impact of cannabis use disorder (CUD) and Pulmonary embolism (PE) on outcomes in female breast cancer survivors, considering reports suggesting significant overlap between recreational and medicinal use. Our objective was to compare outcomes in CUD+ (with cannabis use disorder) and CUD- (without cannabis use disorder) cohorts to gain critical insights into this group and understand the impact of CUD on PE-related hospitalization and outcomes. Methods: National Inpatient Sample (NIS) data from 2020 was utilized in order to analyze inpatient cohorts of PE hospitalizations. The International Classification of Diseases 10 (ICD 10) codes for pulmonary embolism, cannabis use disorder, and female breast cancer were utilized to classify cohorts. All cases of female breast cancer and pulmonary embolism with an age &amp;gt;18 years were included in the final analysis. The primary outcome was the impact of CUD on PE-related hospitalizations in female breast cancer survivors. We also compared demographic correlations and comorbidities affecting outcomes between cohorts. Results: This study included a total of 508065 admissions among breast cancer survivors, with a median age of 74 years for the entire cohort. The prevalence of PE admissions was lower in CUD+ cohort compared to CUD- cohort (1.3% vs. 2.1%). The CUD+ cohort was relatively younger (median 66 vs 74 years, p&amp;lt;0.001). Overall, admission rates were higher among white patients (77%) and this trend was statistically significantly higher in the 76-100 th percentile household income group (p&amp;lt;0.002) compared to CUD+(50%) and CUD-(26.5%). Most admissions were non-elective (95.4%), with no statistical significance between CUD- and CUD+ patients (p=0.16). The majority of readmissions occurred in urban teaching hospitals (75.5%), with no significant difference observed between CUD- and CUD+ patients (p=0.111). Regionally, the South had a higher admission rate (37.2%) compared to other regions and this difference was statistically significant (p&amp;lt;0.001) between CUD- and CUD+ patients. Among the coexisting comorbidities, hypertension showed a significant difference between CUD- (70%) and CUD+(37.5%) patients (p&amp;lt;0.001). Alcohol use disorder (p&amp;lt;0.001) and cancer (p&amp;lt;0.001) had significant associations with CUD+, along with prior myocardial infarction (p=0.005) and drug use (p&amp;lt;0.001) were significantly associated with CUD+.Furthermore, there was difference in routine patient disposition between between CUD-(45.3%) and CUD+(37.5%),(p=0.033) and length of stay (4 VS 2 days), (p=0.033) and cost of stay (47033 vs 27668 $), (p=0.017). The multivariable logistic regression analysis showed that the odds of PE-related hospitalization in CUD+ vs CUD- cohorts among female breast cancer survivors were not statistically significant, with an OR of 0.79 (CI: 0.38-1.62, p=0.512). Subgroup analysis by age demonstrated no statistically significant differences in odds for PE-related hospitalization between CUD+ and CUD- cohorts. For the age group of 18-44 years, the OR was 1.37 (CI: 0.18-10.60, p=0.762). In the 45-64 years age group, the OR was 0.48 (CI: 0.15-1.53, p=0.215), and for those aged ≥65 years, the OR was 1.32 (CI: 0.48-3.67, p=0.590). Furthermore, the analysis by race indicated that the odds of PE-related hospitalization did not reach statistical significance in both white and black female breast cancer survivors with CUD. For white patients, the OR was 0.64 (CI: 0.23-1.73, p=0.375), while for black patients, the OR was 1.15 (CI: 0.38-3.46, p=0.804). Conclusion: Among female breast cancer survivors, the presence of CUD did not show a statistically significant impact on the odds of PE-related hospitalization. Subgroup analysis by age and race also revealed no significant differences in the odds of PE-related hospitalization between CUD+ and CUD- cohorts. These findings underscore the importance of considering CUD when managing pulmonary embolism in breast cancer survivor females and emphasize the need for further research to understand the complex interplay between these factors.

Catheter-based therapy for intermediate or high-risk pulmonary embolism is associated with lower in-hospital mortality in patients with cancer: Insights from the National Inpatient Sample.

Pulmonary embolism (PE)is a common complication among patients with cancer and is a significant contributor to morbidity and mortality. Catheter-based therapies (CBT),including catheter-directed thrombolysis (CDT)and mechanical thrombectomy, have been developed and are used in patients with intermediate or high-risk PE. However, there is a paucity of data on outcomes in patients with cancer as most clinical studies exclude this group of patients. To characterize outcomes of patients with cancer admitted with intermediate or high-risk PE treated with CBT compared with no CBT. Patients with an admission diagnosis of intermediate or high-risk PE and a history of cancer from October 2015 to December 2018 were identified using the National Inpatient Sample. Outcomes of interest were in-hospital death or cardiac arrest (CA)and major bleeding. Inverse probability treatment weighting (IPTW)was utilized to compare outcomes between patients treated with and without CBT. Variables that remained unbalanced after IPTW were adjusted using multivariable logistic regression. A total of 2084 unweighted admissions (10,420 weighted) for intermediate or high-risk PE and cancer were included, of which 136 (6.5%) were treated with CBT. After IPTW, CBT was associated with lower death or CA (aOR 0.54, 95% CI 0.46-0.64) but higher major bleeding (aOR1.41, 95% CI 1.21-1.65). After stratifying by PE risk type, patients treated with CBT had lower risk of death or CA in both intermediate (aOR0.52, 95% CI 0.36-0.75) and high-risk PE (aOR0.48, 95% CI 0.33-0.53). However, patients with CBT were associated with increased risk of major bleeding in intermediate-risk PE (aOR2.12, 95% CI 1.67-2.69) but not in those with high-risk PE (aOR0.84, 95% CI 0.66-1.07). Among patients with cancer hospitalized with intermediate or high-risk PE, treatment with CBT was associated with lower risk of in-hospital death or CA but higher risk of bleeding. Prospective studies and inclusion of patients with cancer in randomized trials are warranted to confirm our findings.

Prevalence and Impact of COVID-19 in Young Women of Reproductive Age [18-44 Years] Hospitalized with Pulmonary Embolism in the US in 2020 Using National Inpatient Sample Dataset, in-Hospital Mortality, Racial Disparity and Predictors of Mortality

Title: Prevalence and Impact of COVID -19 on In-hospital Outcomes and Associated Racial Disparities in Young Women of Reproductive Age Group (18-44 years) Hospitalized with Pulmonary Embolism in the US in 2020 Background: Given the potential of thrombotic events such as pulmonary embolism in COVID-19, it is essential to comprehend the specific risks and effects on young women of reproductive age, a high-risk group for venous thromboembolism. There is a paucity of data regarding the prevalence and impact of COVID-19 in young women within the reproductive age group who were hospitalized with pulmonary embolism (PE) in the United States during the year 2020. Methods: Utilizing the National Inpatient Sample (NIS) 2020 and relevant ICD-10-CM codes, we identified admissions for PE with COVID-19 vs. without COVID-19 among Young Women [18-44 years] hospitalized with PE. We compared the baseline characteristics and comorbidities between the two groups with and without COVID-19. Furthermore, we analyzed the multivariable adjusted odds ratio (OR) of all-cause mortality in COVID-19 with the non-COVID-19 cohort as a referent, subgroup odds for white vs. other races, and effect modification by diabetes mellitus (DM) as a comorbidity. Results: We identified 34,730 hospitalizations in young female patients of the reproductive age group (18 to 44 years) in 2020 with the diagnosis of PE, of which 2345 (6.8%) had COVID-19. The prevalence of PE was higher in COVID-19 cohort (1.6% vs. 0.6%, p&amp;lt;0.001). The majority of the patients with PE were Caucasian (58.9%) and in the lowest median income quartile (36.9%). Analysis of various comorbidities in both cohorts revealed a statistically significant higher prevalence of hypertension (29.6% in those with COVID-19 vs. 24.3% in those without COVID-19, p &amp;lt;0.001), Similarly, hyperlipidemia (11.7% vs. 7.3%, p &amp;lt;0.001), DM (20.9% vs. 12.4%, p &amp;lt;0.001), and obesity (50.3% vs. 32.7%, p &amp;lt;0.001), were more prevalent in COVID-19, indicating that patients who were admitted with PE with concomitant COVID-19 were of poorer overall cardiovascular health than those with COVID-19. Unadjusted all-cause mortality odds ratio was 2.41 (1.71-3.38, p &amp;lt;0.001) in PE with COVID-19 than non-COVID-19. Adjusted all-cause mortality for demographics, hospital level covariates, and pre-existing conditions revealed similar statistically significant findings, with the odds ratio being 2.8 (1.94-4.04, p &amp;lt;0.001). There was no racial disparity observed in all-cause mortality for non-whites compared to white patients admitted with PE and COVID-19 (p=0.064). Furthermore, all-cause mortality in patients with COVID-19 and PE was found to have an odds ratio of 3.04 (1.05-8.81, p=0.041) in a subset of DM compared to non-DM. The results have confirmed a further robust positive association with increasing mortality risk with DM in young women hospitalized with PE and COVID-19. Conclusion and Relevance: There was a nearly three times higher prevalence of PE and 2.5 times higher odds of mortality in Young Women of Reproductive age [18-44 years] hospitalized with PE with COVID-19 as compared to without COVID-19. The effect of PE and a higher risk of mortality are already established with COVID-19; however, there is a paucity of data in young women, which warrants more prospective studies to evaluate the long-term thromboembolic risks of PE and associated events in this population. The findings of this research could have significant implications for understanding the relationship between COVID-19 and PE in this patient population. Special emphasis needs to be laid on improved healthcare strategies, targeted interventions, and patient education in this cohort to establish future research agendas and provide better health care outcomes for this vulnerable group with established risk factors like diabetes. Key Words: COVID-19, Young Women, Pulmonary Embolism, In-Hospital Mortality, Racial Disparity, Predictors of Mortality, Diabetes Mellitus, National Inpatient Sample

SAT464 Hyperthyroidism Does Not Negatively Impact Outcomes of Adult Hospitalizations for Pulmonary Embolism: A Nationwide Analysis

Abstract Disclosure: A.G. Olafimihan: None. V. Deenadayalan: None. P.E. Ojemolon: None. R. Litvin: None. U.A. Ogar: None. E. Krishnaraju: None. F. Sami: None. E.H. Olojakpoke: None. Introduction: Acute pulmonary embolism (PE) is a medical emergency associated with high mortality rates. Hyperthyroidism has been associated with an increased risk of venous thromboembolism and PE. However, there are limited studies on its impact on the outcomes of patients with PE. We aimed to assess hyperthyroidism’s effect on in-hospital PE outcomes using the National Inpatient Sample (NIS). Methods: Data were extracted from the US Nationwide Inpatient Sample (NIS) from 2016 to 2019. The NIS contains hospital discharge information estimating yearly US hospitalizations. We included hospitalizations with a principal discharge diagnostic code for PE using the ICD-10-CM code (E22.2). Hospitalizations of patients less than 18 years of age were excluded from the study. This cohort was divided based on the secondary diagnosis of hyperthyroidism.The primary outcome was inpatient mortality, and secondary outcomes were hospital length of stay (LOS), total hospital charge, odds of acute respiratory failure (ARF), acute renal failure (AKI), undergoing embolectomy, tissue plasminogen activator (tPA) use and Inferior vena cave (IVC) filter placement. Multivariate linear regression analysis was used to adjust for confounders. Statistical significance was set at a p-value &amp;lt; 0.05. Results: There were 745,360 hospitalizations involving PE as the reason for admission, and 20.1% had comorbidity with hyperthyroidism. Admissions for PE with comorbid hyperthyroidism had similar in-hospital mortality (adjusted OR:1.17, P=0.41), mean LOS (4.9 vs 4.3 days, P=0.11) and mean THC ($53,127 vs $48,236, P=0.43) compared to those without hyperthyroidism. The odds of developing ARF (aOR: 0.93, P=0.466) or AKI (aOR: 0.95, P=0.71) were similar. Odds of undergoing embolectomy (aOR: 1.07, p=0.83), receiving tPA (aOR=1.03, P=0.87) and placing IVC filter (aOR=0.80, P=0.19) were similar between both groups. Conclusion: Hospitalizations for pulmonary embolism with hyperthyroidism had similar inpatient mortality compared to those without hyperthyroidism. Also, mean LOS, total hospital charge, ARF and AKI complications, and odds of embolectomy, tPA administration and IVC filter placement were alike for both categories. Presentation Date: Saturday, June 17, 2023

Predictors of cancer in patients with acute pulmonary embolism

BackgroundAcute pulmonary embolism (PE) can occur as a manifestation of an underlying cancer and be of paraneoplastic aetiology. A previously unknown cancer is sometimes diagnosed after the acute PE diagnosis. The identification of a group of patients with elevated probability of having an occult cancer underlying PE was never performed. We aimed to determine predictors of occult cancer in acute PE. Our hypothesis was that the D-dimer levels would be a predictor of cancer. Patients and methodsWe retrospectively analysed a cohort of patients hospitalized with acute PE. Exclusion criteria: <18 years, venous embolism only of veins other than pulmonary territory or when the embolism was considered chronic, and no image confirmation of acute PE. Patients were grouped according to the timing of cancer diagnosis: 1) known concomitant active cancer, 2) cancer diagnosed during acute PE admission or in the following 2 years and, 3) no known cancer during the 2-year follow-up since PE diagnosis. Predictors of concomitant cancer were determined using a logistic regression analysis. Multivariate models were built. ResultsWe studied 562 patients; median age was 72 years and 219 (39.0 %) were men. In 223 (39.7 %) of the patients the PE was of central arteries and 61.4 % presented with bilateral PE. PE was considered unprovoked at time of discharge in 47.7 %. Median (interquartile range) D-dimer level was 7.98 (3.30–14.99) μg/mL. A total of 126 (22.4 %) patients were in group 1, 47 in group 2 (cancer diagnosed after the diagnosis of acute PE and up to 2 years) and 389 patients were in group 3. Elevated D-dimer levels were independently associated with already known cancer. D-dimer were independent predictors of future cancer diagnosis: OR = 1.07 ((95 % CI: 1.01–1.14) per each 5 ng/mL increase; for patients with D-dimer >15.0 μg/mL the OR of future cancer was 2.10 (1.05–4.18). If only patients with unprovoked PE upon admission (n = 307) were to be considered results were similar considering D-dimer; anaemia also predicted unknown cancer [OR = 2.13 (1.08–4.16)]. ConclusionsPatients with D-dimer >15 μg/mL presented a >2-fold higher risk of being diagnosed with a cancer condition in the upcoming 2 years. D-dimer may help clinicians in identifying which patients are at higher risk of occult cancer.

Neighborhood Socioeconomic Disadvantage, Healthcare Access, and Outcomes of Hospitalizations for Common Pulmonary Conditions: A National Study of Medicare Beneficiaries.

Rationale: Understanding how systemic forces and environmental exposures impact patient outcomes is critical to advancing health equity and improving population health for patients with pulmonary disease. This relationship has not yet been assessed at the population level nationally. Objectives: To determine whether neighborhood socioeconomic deprivation is independently associated with 30-day mortality and readmission for hospitalized patients with pulmonary conditions, after controlling for demographics, access to healthcare resources, and characteristics of admitting healthcare facilities. Methods: This was a retrospective, population-level cohort study of 100% of United States nationwide Medicare inpatient and outpatient claims from 2016-2019. Patients were admitted for one of four pulmonary conditions (pulmonary infections, chronic lower respiratory disease, pulmonary embolism, and pleural and interstitial lung diseases), defined by diagnosis-related group. The primary exposure was neighborhood socioeconomic deprivation, measured by the area deprivation index. The main outcomes were 30-day mortality and 30-day unplanned readmission, defined by Centers for Medicare and Medicaid Services methodologies. Generalized estimating equations were used to estimate logistic regression models for the primary outcomes, addressing clustering by hospital. A sequential adjustment strategy was first adjusted for age, legal sex, Medicare-Medicaid dual eligibility, and comorbidity burden, then adjusted for metrics of access to healthcare resources, and finally adjusted for characteristics of the admitting healthcare facility. Results: After full adjustment, patients from low socioeconomic status neighborhoods had greater 30-day mortality after admission for pulmonary embolism (odds ratio [OR], 1.26; 95% confidence interval [CI], 1.13-1.40), respiratory infections (OR, 1.20; 95% CI, 1.16-1.25), chronic lower respiratory disease (OR, 1.31; 95% CI, 1.22-1.41), and interstitial lung disease (OR, 1.15; 95% CI, 1.04-1.27) when compared to patients from the highest SES neighborhoods. Low neighborhood socioeconomic status was also associated with 30-day readmission for all groups except the interstitial lung disease group. Conclusions: Neighborhood socioeconomic deprivation may be a key factor driving poor health outcomes for patients with pulmonary diseases.

C-34 | Impact of Timing of Catheter-Directed Thrombolysis in Pulmonary Embolism on In-Hospital Outcomes

Catheter-Directed Thrombolysis (CDT) has emerged as an acceptable and safe modality in the treatment of intermediate to high-risk pulmonary embolism (PE). It is currently unknown whether in-hospital outcomes are affected by early (<48 hours) versus late (>48 hours) initiation of CDT from time of admission of patients with PE. The National Inpatient Sample database was queried from the years 2016-2019 to obtain our sample of PE admissions using appropriate ICD-10-CM codes. Those with concurrent acute limb ischemia, ischemic stroke, stenting or bypass procedures in the same admission were excluded. Our cohort was divided into those who underwent early or late intervention with CDT. Outcomes were measured using multivariate logistic regression and propensity score matching to obtain adjusted odds ratios (aOR). 27,435 patients received CDT, of which 22,650 underwent early intervention and 3,935 underwent late intervention. After propensity score matching, no differences in the likelihood of mortality (aOR 0.84, p=0.194) and vasopressor use (aOR 1.04, p=0.863) were found between the two interventions. The late intervention group had higher likelihood of concurrent need for systemic thrombolysis (aOR 1.66, p<0.01), blood transfusions (aOR 1.36, p<0.01), and intubation (aOR 1.31, p=0.01). Delaying CDT in patients with intermediate to high-risk PE led to a greater need for systemic thrombolysis, blood transfusion, and mechanical ventilation but did not lead to increase in-hospital mortality. Future randomized clinical trials should focus on the timing of CDT in PE to further elucidate its effects.

Impact of Pleural Effusion on Clinical Outcomes in Patients with Pulmonary Embolism: Insights from the National Inpatient Sample.

The incidence of hospital admissions for pulmonary embolism (PE) and associated pleural effusion, and the impact of these effusions on outcomes on a national level is unknown. Data from the National Inpatient Sample between 2016 to 2019 was used to conduct a retrospective nationwide cohort study of hospital admissions for PE with and without pleural effusion. Multiple logistic regressions and linear regression analyses were used to determine the independent impact of effusions on in-hospital mortality, length of stay, and cost. There were 937,744 hospital admissions with PE included in our analysis (median age 64 [interquartile range 50-76] years; 52.5% females). The in-hospital mortality rate overall was 3.7% which was 5.5% for patients with pleural effusion and 3.6% for patients without pleural effusion (p<0.001). The median length of stay was longer in the group with pleural effusion (6 [3-12] days vs 4 [2-6] days, p<0.001) and the median healthcare cost was higher among patients with pleural effusion (13,689 [7,279-30,915] vs 8,855 [5,472-16,531], p<0.001). The factors most associated with pleural effusion were atrial fibrillation (OR 1.89 95%CI 1.78-2.00, p<0.001) and arterial thrombosis (OR 1.48 95%CI 1.19-1.84, p<0.001). Pleural effusion was associated with increased odds of mortality in patients with PE (OR 1.30 95%CI 1.18-1.45, p<0.001). Pleural effusion was associated with increased length of stay (Coefficient 4.15 95%CI 3.99 to 4.32, p<0.001), and healthcare costs (Coefficient 12,164; 95%CI:11,639 to 12,688, p<0.001)). Concomitant pleural effusion is not uncommon among PE patients which is more common in patients with atrial fibrillation and previous arterial thrombosis. Pleural effusions in patients with PE are associated with higher in-hospital mortality, length of stay and cost.

Predictors of acute pulmonary embolism-related hospitalizations – an artificial neural network analysis using a nationwide cohort in the United States

Abstract Background Considering a paucity of large-scale data on predictors of pulmonary embolism (PE) and its higher association with complications and worse outcomes, we aimed to determine the predictors of PE in this United States population-based analysis using Artificial Neural Network (ANN) Model in a nationally representative cohort. Methods We identified PE-related hospitalizations using 2018's National Inpatient Sample database. The relevant predictive factors for ANN were selected for this cohort. Of all admissions (unweighted n=7,105,498, weighted n=35,527,481), PE cohort (weighted n=387805) consisted of 1.1% of all admissions in 2018. The 2018 cohort was randomly split into training data (unweighted n=4716132, 70.0%) which were used to calibrate ANN and testing data (unweighted n=2019290, 30%) which were used to assess the accurateness of the algorithm. We equated the rate of incorrect prediction between training and testing data and measured the Area under Receiver Operator Curve (AUC) to determine ANN's efficacy in predicting PE hospitalizations. Results Patients hospitalized with PE often consisted of older (mean age 62.5±17.1 years), female (51.3%), white (70.5%) patients, and patients from lower-income quartile (0–25% income quartile: 28.8%%), often admitted non-electively (93.7%) with higher rates of cardiovascular disease risk factors. PE admissions revealed significantly higher (6.5% vs. 1.9%, p&amp;lt;0.001) in-hospital mortality, less frequent routine discharges (51.4% vs. 68.1%) and more frequent other facility transfers and requirement of home health care. Normalized Predictors of PE admissions are displayed in Fig. 1. Our ANN model had AUC 0.873 which correlates with an excellent prediction model. Our data demonstrated low levels (0.8%) error in both testing and training models. Conclusion Our ANN model showed high performance to predict risk factors for PE admissions in the US population. It will enable clinicians to screen patients at high-risk for PE admissions, curtail complication rate, improve survival and lower the healthcare cost. Funding Acknowledgement Type of funding sources: None.

CANNABIS USE DISORDER: FRIEND OR FOE IN PULMONARY EMBOLISM AND ASSOCIATED MORTALITY IN YOUNG ADULTS (AGED 18-44 YEARS)?

CANNABIS USE DISORDER: FRIEND OR FOE IN PULMONARY EMBOLISM AND ASSOCIATED MORTALITY IN YOUNG ADULTS (AGED 18-44 YEARS)?

Pulmonary Embolism Readmission Trend Over the Years (from a National Readmission Database)

With the evolution of pulmonary embolism (PE) management, the outcomes of PE-related complications and the need for readmission have not been well studied. The aim of this study is to see the trend in readmissions in patients with PE from 2010 to 2018. We used the National Readmission Database from 2010 to 2018 to identify hospitalized patients with a principal diagnosis of acute PE. We then identified the total number of readmissions for acute PE from 2010 to 2018. These were further stratified based on readmission within 30 days and readmission within 90 days. A multivariate Cox regression model was used to adjust for confounding factors. The 30-day all-cause readmission after principal admission for PE decreased from 11.2% to 9.7% from 2010 to 2014 but increased to 11.8% in 2018 (p <0.001). A similar trend was seen in 90-day readmission. Risk-adjusted readmission specific for PE showed a decrease from 1.2% to 1% (p=0.004) in the 30-day cohort and from 1.4% to 1.2% (p=0.006) in the 90-day cohort from 2010 to 2018. When adjusted to age and gender, an increase in the proportion of readmissions with intracranial bleeding was seen among both the 30-day (0.7% in 2010 to 1.2% in 2018, adjusted odds ratio [aOR] 1.06, p=0.006) and 90-day (0.7% in 2010 to 1.2% in 2018, aOR 1.06, p-trend=0.003) cohorts. Similarly, an increasing trend of readmissions for upper gastrointestinal bleed was seen among both 30-day (0.9% vs 4.3%, aOR 1.26, p-trend <0.001) and 90-day (0.7% vs 3.8%, aOR 1.27, p-trend <0.001) readmissions. Our study suggests that there is a statistically significant decrease in PE-specific readmission from 2010 to 2018 but a variable trend in all-cause readmissions. We also report an increase in bleeding during readmissions, including intracranial hemorrhage and upper gastrointestinal bleed. In conclusion, these findings warrant further studies to elucidate the mechanism for decreasing PE-specific readmission and possible causes for the increase in all-cause readmissions.

Hospital procedural volume and outcomes with catheter-directed intervention for pulmonary embolism: a nationwide analysis.

There is limited data on the association between hospital catheter-directed intervention (CDI) volume and outcomes among patients with acute pulmonary embolism (PE). The Nationwide Readmissions Database years 2016-2019 was utilized to identify hospitalizations undergoing CDI for acute PE. Hospitals were divided into tertiles based on annual CDI volume; low-volume (1-3 procedures), moderate-volume (4-12 procedures) and high-volume (>12 procedures). The primary outcome was all-cause in-hospital mortality. Among 1 436 382 PE admissions, 2.6% underwent CDI; 5.6% were in low-volume, 17.3% in moderate-volume and 77.1% in high-volume hospitals. There was an inverse relationship between hospital CDI volume and in-hospital mortality (coefficient -0.344, P < 0.001). On multivariable regression analysis, hospitals with high CDI volume were associated with lower in-hospital mortality compared with hospitals with low CDI volume (adjusted odds ratio [OR] 0.71; 95% confidence interval [CI] 0.53, 0.95). Additionally, there was an inverse association between CDI volume and length of stay (LOS) (regression coefficient -0.023, 95% CI -0.027, -0.019) and cost (regression coefficient -74.6, 95% CI -98.8, -50.3). There were no differences in major bleeding and 30-day unplanned readmission rates between the three groups. In this contemporary observational analysis of PE admissions undergoing CDI, there was an inverse association between hospital CDI volume and in-hospital mortality, LOS, and cost. Major bleeding and 30-day unplanned readmission rates were similar between the three groups.

Outcomes of pulmonary embolism in patients with pancreatic cancer: A nationwide inpatient sample study.

e16235 Background: Pancreatic cancer is considered one of the most aggressive cancers with five-year relative survival of 10.8% as per the national institute of health (NIH); Thromboembolism is a well-known complication of pancreatic cancer which contributes to increased morbidity, mortality and burden on the health care system. We attempted to evaluate the outcomes of pulmonary embolism in patients with pancreatic cancer. Methods: Healthcare Cost and Utilization Project National Inpatient Sample (HCUP-NIS) was queried to identify Pulmonary embolism admissions between 2016-2018 In Adult patients with diagnosis of pancreatic cancer using International Classification of Disease 10th Revision (ICD-10) codes. We evaluated mortality, Need for ventilation, Tissue plasminogen activator (TPA) administration, Embolectomy, Inferior vena cava (IVC) filter insertion and Acute kidney injury. Secondary outcomes included mean length of stay (LOS) and the mean cost of hospitalization. Results: A total 5335 admissions with PE and Pancreatic cancer were identified; in the baseline characteristics mean age was 67.4 at time of diagnosis with 51% being females and the white race constituted 73% of the total admissions. 385 patients (7%) died during hospitalization,165 patients (3%) required ventilation, 140 patients (2.6%) had TPA administration,560 patient (10.4%) had IVC inserted, 640 patients (12%) developed Acute kidney injury, and none had embolectomy. Mean length of stay was around 5 days and the mean cost of hospitalization was $12405. Conclusions: Pulmonary embolism increases mortality among patients with Pancreatic cancer; in addition to its effect on morbidity and burden on health care system; Efforts should be made to identify those with pancreatic cancer and considered high risk for Venous thromboembolism who may benefit from primary prophylaxis.

Contemporary National Trends and Outcomes of Pulmonary Embolism in the United States

Contemporary data on the national trends in pulmonary embolism (PE) admissions and outcomes are scarce. We aimed to analyze trends in mortality and different treatment methods in acute PE. We queried the Nationwide Readmissions Database (2016 to 2019) to identify hospitalizations with acute PE using the International Classification of Diseases, Tenth Revision, Clinical Modification codes. We described the national trends in admissions, in-hospital mortality, readmissions, and different treatment methods in acute PE. We identified 1,427,491 hospitalizations with acute PE, 2.4% of them (n=34,446) were admissions with high-risk PE. The rate of in-hospital mortality in all PE hospitalizations was 6.5%, and it remained unchanged throughout the study period. However, the rate of in-hospital mortality in high-risk PE decreased from 48.1% in the first quarter of 2016 to 38.9% in the last quarter of 2019 (p-trend <0.001). The rate of urgent 30-day readmission was 15.2% in all PE admissions and 19.1% in high-risk PE admissions. In all PE admissions, catheter-directed interventions (CDI) were used more often (2.5%) than systemic thrombolysis (ST) (2.1%). However, in admissions with high-risk PE, ST remained the most frequently used method (ST vs CDI: 11.3% vs 6.6%). In conclusion, this study showed that the rate of in-hospital mortality in high-risk PE decreased from 2016 to 2019. ST was the most frequently used method for achieving pulmonary reperfusion in high-risk PE, whereas CDI was the most frequently used method in the entire PE cohort. In-hospital death and urgent readmissions rates remain significantly high in patients with high-risk PE.

Evaluating the Appropriateness of Pulmonary Embolism Admissions in a Community Hospital Emergency Department.

Pulmonary embolism (PE) is a diagnosis on the broader spectrum of venous thromboembolic (VTE) disease. The diagnostic key for clinicians is detecting which patients have a “high risk” of complications or mortality and who are in the “low-risk” population. The Pulmonary Embolism Severity Index (PESI) and HESTIA scores are validated risk stratification tools to determine if patients diagnosed with PE can be successfully managed in the outpatient versus inpatient setting. We aimed to investigate the appropriateness of PE admissions to our institution based on the risk stratification recommendations from PESI and HESTIA scores.We retrospectively identified 175 patients admitted with a diagnosis of PE over one year at our hospital. Baseline demographics, length of admission, and admitting diagnoses were collected for all patients included in this study. PESI and HESTIA scores were then calculated for all included patients.The average PESI score was 91.65 (95% confidence interval: 86.33, 96.97). There were 87 patients (49.7%) that had a low or very low PESI score of fewer than 85 points. Fifty-seven patients (33.7%) presented with a HESTIA score of 0. The risk stratification score indicates these patients as low risk, and appropriate for outpatient management. However, they were instead admitted to the hospital which contributes to increased costs, risk of adverse events, etc. There were 0 mortalities reported for patients in the "low or very low risk" groups, with four reported mortalities in the “very high risk” groups. In our cohort, 33.7%-49.7% of admissions for PE were risk-stratified as “low risk” and qualified for outpatient management based on HESTIA and PESI risk stratification scores, respectively. The underutilization of validated risk scores upon initial diagnosis of PE may lead to worse outcomes and increased healthcare expenditure.

Predictors of anticoagulation adherence in patients with acute pulmonary embolism

BackgroundAnticoagulation (AC) adherence after acute pulmonary embolism (PE) is vital to prevent mortality and future recurrence of venous thromboembolism (VTE). We aimed to analyze factors affecting AC adherence after acute PE. MethodsConsecutive adult patients with CT angiography or V/Q scan confirmed acute PE were included in a single-center retrospective study from April 2016 to May 2020. Adherence data, including AC refill dates, were collected from pharmacies, and adherence measures including Continuous Measure of Medication Acquisition (CMA), Proportion of Days Covered (PDC), and Optimal Medication Adherence (OMA) were calculated per standardized formulas. Univariable and multivariable linear and logistic regression was used to analyze different variables affecting AC adherence. ResultsA total of 118 out of 144 patients had sufficient follow-up data to measure adherence and were included in the final analysis. Mean age was 60 ± 15 years, with 64 (54.2%) women; 70 (59.3%) White, 26 (22%) African American, 13 (11%) Hispanic; 58 (49.2%) patients had private insurance, 48 (40.7%) Medicare, 11 (9.3%) Medicaid. Type of AC comprised of 57 (48.3%) apixaban, 17 (14.4%) rivaroxaban, 8 (6.8%) warfarin, 6 (5.1%) enoxaparin, and 30 (25.4%) patients with changing AC. In univariable regression, African American and Medicaid-insured patients had significantly lower adherence, while advancing age, apixaban usage, and 30-day follow-up clinic visit showed a higher adherence. However, in multivariable regression, African American race (PDC -0.135, p = 0.006, CI (−0.231, −0.040) | OMA Adjusted OR 0.166, p = 0.030, CI (0.033, 0.837)) and other non-White, non-Hispanic races (PDC -0.314, p = 0.009, CI (−0.548, −0.080)) were associated with lower AC adherence. ConclusionIn our study, African American and other minority race patients showed lower AC adherence after hospital admission for acute PE. Further studies are needed to address underlying contributors and improve adherence in this population.