Hospitalization For Pulmonary Embolism Research Articles

Racial, Biological Sex, and Geographic Disparities of Venous Thromboembolism in the United States, 2016–2019

Venous thromboembolism (VTE) stands as the leading cause of preventable death within hospitals in the United States. While there have been some studies investigating incidence rates of VTE, there has yet to be a large-scale study elucidating disparities in sex, race, income, region, and seasons in patients with VTE. The goal of this study was to report the disparities in race, sex, income, region, and seasons in patients with VTE, pulmonary embolism (PE), and deep vein thrombosis (DVT), in hospitalized patients from 2016-2019. We used the United States National Inpatients Sample database to identify inpatients diagnosed with PE, DVT, and PE & DVT from 2016 to 2019. The inpatient incidence per thousand was calculated for sex and race using the weighted sample model. The regional and monthly incidence of DVT and PE per thousand inpatients and risk of incidence were calculated. Patients' characteristics including hospital type, bed size, median length of stay, median total charges, and mortality were also collected. We examined 455,111 cases of VTE, 177,410 cases of DVT, 189,271 cases of PE, and 88,430 cases of both DVT and PE combined. Over the study period, we observed a statistically significant trend among PE hospitalization incidences. There was a strong and positive correlation between DVT and PE inpatients. Black inpatients had the highest cumulative incidence of hospitalizations in all cohorts with 10.36/1000 in PE, and 9.1/1000 in DVT. Asian and Pacific Islander inpatients had the lowest cumulative incidence with 4.42/1000 in PE and 4.28/1000 in DVT. Females showed the lowest cumulative incidence with 7.47/1000 in PE and 6.53/1000 in DVT. Mountain region was the highest among PE hospitalizations with 9.62/1000. For DVT, Middle Atlantic region was the highest at 8.65/1000. The in-hospital mortality was the highest among the PE hospitalizations with 7.3%. Also, the trend analysis showed significant increases among all groups. Over the study period (2016-2019), we reported the racial, biological sex, and geographical disparities from the National Inpatient Sample database, highlighting that Black inpatients had the highest incidence of PE and DVT, while Asian / Pacific Islander inpatients had the lowest incidence of PE and DVT. Moreover, women had lower incidence compared to men. The observed regional variations indicated that the incidence of PE was highest in the Mountain region, whereas the incidence of DVT was lowest in the Middle Atlantic region. There was an increase in the mortality of inpatients diagnosed with VTE reflecting the growing burden of this condition in the U.S. healthcare system.

Drivers and recent trends of hospitalisation costs related to acute pulmonary embolism.

The socio-economic burden imposed by acute pulmonary embolism (PE) on European healthcare systems is largely unknown. We sought to determine temporal trends and identify cost drivers of hospitalisation for PE in Germany. We analysed the totality of reimbursed hospitalisation costs in Germany (G-DRG system) in the years 2016-2020. Overall, 484 884 PE hospitalisations were coded in this period. Direct hospital costs amounted to a median of 3572 (IQR, 2804 to 5869) euros, resulting in average total reimbursements of 710 million euros annually. Age, PE severity, comorbidities and in-hospital (particularly bleeding) complications were identified by multivariable logistic regression as significant cost drivers. Use of catheter-directed therapy (CDT) constantly increased (annual change in the absolute proportion of hospitalisations with CDT + 0.40% [95% CI + 0.32% to + 0.47%]; P < 0.001), and it more than doubled in the group of patients with severe PE (28% of the entire population) over time. Although CDT use was overall associated with increased hospitalisation costs, this association was no longer present (adjusted OR 1.02 [0.80-1.31]) in patients with severe PE and shock; this was related, at least in part, to a reduction in the median length of hospital stay (for 14.0 to 8.0days). We identified current and emerging cost drivers of hospitalisation for PE, focusing on severe disease and intermediate/high risk of an adverse early outcome. The present study may inform reimbursement decisions by policymakers and help to guide future health economic analysis of advanced treatment options for patients with PE.

Community Socioeconomic Status, Acute Cardiovascular Hospitalizations, and Mortality in Medicare, 2003 to 2019.

Socioeconomically disadvantaged communities in the United States disproportionately experience poor cardiovascular outcomes. Little is known about how hospitalizations and mortality for acute cardiovascular conditions have changed among Medicare beneficiaries in socioeconomically disadvantaged and nondisadvantaged communities over the past 2 decades. Medicare files were linked with the Centers for Disease Control and Prevention's social vulnerability index to examine age-sex standardized hospitalizations for myocardial infarction, heart failure, ischemic stroke, and pulmonary embolism among Medicare fee-for-service beneficiaries ≥65 years of age residing in socioeconomically disadvantaged communities (highest social vulnerability index quintile nationally) and nondisadvantaged communities (all other quintiles) from 2003 to 2019, as well as risk-adjusted 30-day mortality among hospitalized beneficiaries. A total of 10 942 483 Medicare beneficiaries ≥65 years of age were hospitalized for myocardial infarction, heart failure, stroke, or pulmonary embolism (mean age, 79.2 [SD, 8.7] years; 53.9% female). Although age-sex standardized myocardial infarction hospitalizations declined in socioeconomically disadvantaged (990-650 per 100 000) and nondisadvantaged communities (950-570 per 100 000) from 2003 to 2019, the gap in hospitalizations between these groups significantly widened (adjusted odds ratio 2003, 1.03 [95% CI, 1.02-1.04]; adjusted odds ratio 2019, 1.14 [95% CI, 1.13-1.16]). There was a similar decline in hospitalizations for heart failure in socioeconomically disadvantaged (2063-1559 per 100 000) and nondisadvantaged communities (1767-1385 per 100 000), as well as for ischemic stroke, but the relative gap did not change for both conditions. In contrast, pulmonary embolism hospitalizations increased in both disadvantaged (146-184 per 100 000) and nondisadvantaged communities (153-184 per 100 000). By 2019, risk-adjusted 30-day mortality was similar between hospitalized beneficiaries from socioeconomically disadvantaged and nondisadvantaged communities for myocardial infarction, heart failure, and ischemic stroke but was higher for pulmonary embolism (odds ratio, 1.10 [95% CI, 1.01-1.20]). Over the past 2 decades, hospitalizations for most acute cardiovascular conditions decreased in both socioeconomically disadvantaged and nondisadvantaged communities, although significant disparities remain, while 30-day mortality is now similar across most conditions.

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.

Abstract 15011: Recent Trends in Interventional Treatment of Acute Pulmonary Embolism and Their Implications for a National Healthcare System

Introduction: Catheter-directed treatment (CDT) of acute pulmonary embolism (PE) is gaining popularity in Europe, following a trend that originated earlier in the US. For healthcare systems, reimbursement of CDT depends on their clinical benefits along with assessing the impact on hospital costs. Hypothesis-Aims: To estimate how increasing use of CDT, as reflected by prospective US data, may affect costs of PE treatment in the German hospital remuneration system (G-DRG). Methods: We analyzed data from the German nationwide inpatient sample (Federal Statistical Office), covering all hospitalizations for PE, for the years 2018-2019. For the same period, we analyzed prospective patient-level data from the multicenter US registry of the Pulmonary Embolism Response Team (PERT) Consortium. Results: During the study period, 196,167 patients were hospitalized for acute PE in Germany. Of these, 64,056 (33%) had intermediate-risk or high-risk PE, but overall ≤ 1% received CDT. Median reimbursement was є3,572 (IQR, 2,804-5,869), corresponding to є4,088 in inflation-adjusted 2022 currency ($5,678, adjusted for purchase parity power). Of 1,349 patients with intermediate- or high-risk PE included in the US registry in 2018-2019, 284 (21%) received CDT, mostly aspiration thrombectomy (63/1,349; 4.7%), ultrasound-assisted catheter thrombolysis (151; 11.2%), or non-assisted catheter thrombolysis (47; 3.5%). Median length of stay was 4.5 (2.8-8.2) days. Based on current reimbursement rates in the G-DRG, fees for PE treated with aspiration thrombectomy amount to є12,179-15,753, and for catheter-directed thrombolysis (with or without ultrasound) to є9,858-13,829. Considering, (a) the shorter length of stay; (b) the proportion of patients receiving CDT in the elevated-risk US cohort in 2018-19; and (c) that of intermediate- and high-risk PE in the German PE inpatient sample, average remuneration per patient would rise from currently є4,088 to є4,724 ($6,552). Conclusions: CDT for PE patients at elevated risk would currently lead to a 16% increase in average per-patient hospital costs in Germany. Together with clinical validation of CDT in ongoing studies, these estimates may inform decision making on reimbursement of interventional treatment options.

Abstract 15445: Extracorporeal Membrane Oxygenation and Reperfusion Strategies in High-Risk Pulmonary Embolism Hospitalizations

Introduction: Extracorporeal membrane oxygenation (ECMO) offers potentially life-saving circulatory support in patients with high-risk pulmonary embolism (PE) and refractory hemodynamic instability. Optimal reperfusion strategies in combination are unclear. Hypothesis: To investigate the contemporary use of ECMO in conjunction with reperfusion strategies in high-risk PE. Methods: We identified high-risk PE hospitalizations in the Nationwide Inpatient Sample (years 2016-2020) and investigated the use of ECMO in conjunction with thrombolysis-based (systemic thrombolysis or catheter-directed thrombolysis) and mechanical (surgical embolectomy or catheter-based thrombectomy) reperfusion strategies with regards to in-hospital mortality and major bleeding. Results: Among 122,735 hospitalizations for high-risk PE ECMO was used in 2,805 (2.3%); stand-alone in 1.4%, with thrombolysis-based reperfusion in 0.4%, and with mechanical reperfusion in 0.5%. Compared to neither reperfusion nor ECMO, ECMO plus thrombolysis-based reperfusion was associated with reduced in-hospital mortality (adjusted OR, 0.60; 95% CI, 0.38-0.97), whereas no difference was found with ECMO plus mechanical reperfusion (1.02; 0.66-1.59), and ECMO stand-alone was associated with increased in-hospital mortality (1.59; 1.21-2.09). In the cardiac arrest subgroup, ECMO was associated with reduced in-hospital mortality (0.71; 0.53-0.93). Among all patients on ECMO, thrombolysis-based reperfusion was significantly associated (0.54; 0.32-0.90), and mechanical reperfusion showed a trend (0.74; 0.47-1.18) towards reduced in-hospital mortality compared to no reperfusion, without increases in major bleeding. Conclusions: In patients with high-risk PE and refractory hemodynamic instability, ECMO may be a valuable supportive treatment in conjunction with reperfusion treatment but not as stand-alone treatment especially for patients suffering from cardiac arrest.

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

Spinal Anesthetic Management for Proteus Syndrome: A Case Report

Proteus syndrome is a rare, complex, and progressive disorder characterized by tissue overgrowth, deformities, and vascular anomalies. We present a case of a 56-year-old patient with Proteus syndrome who underwent successful incision and drainage an ulcerative lesion on a Cerebriform connective tissue nevus on the left plantar surface under spinal anesthesia. The patient had a history of mild lumbar scoliosis and a previous hospitalization for pulmonary embolism. Due to the patient's difficult airway and increased risk of thromboembolism, spinal anesthesia was chosen as the anesthetic technique. The procedure was carried out without complications, and the patient had a satisfactory postoperative recovery.

Pulmonary embolism in United States emergency departments, 2010–2018

Little is known about pulmonary embolism (PE) in the United States emergency department (ED). This study aimed to describe the disease burden (visit rate and hospitalization) of PE in the ED and to investigate factors associated with its burden. Data were obtained from the National Hospital Ambulatory Medical Care Survey (NHAMCS) from 2010 to 2018. Adult ED visits with PE were identified using the International Classification of Diseases codes. Analyses used descriptive statistics and multivariable logistic regression accounting for the NHAMCS’s complex survey design. Over the 9-year study period, there were an estimated 1,500,000 ED visits for PE, and the proportion of PE visits in the entire ED population increased from 0.1% in 2010–2012 to 0.2% in 2017–2018 (P for trend = 0.002). The mean age was 57 years, and 40% were men. Older age, obesity, history of cancer, and history of venous thromboembolism were independently associated with a higher proportion of PE, whereas the Midwest region was associated with a lower proportion of PE. The utilization of chest computed tomography (CT) scan appeared stable, which was performed in approximately 43% of the visits. About 66% of PE visits were hospitalized, and the trend remained stable. Male sex, arrival during the morning shift, and higher triage levels were independently associated with a higher hospitalization rate, whereas the fall and winter months were independently associated with a lower hospitalization rate. Approximately 8.8% of PE patients were discharged with direct-acting oral anticoagulants. The ED visits for PE continued to increase despite the stable trend in CT use, suggesting a combination of prevalent and incident PE cases in the ED. Hospitalization for PE remains common practice. Some patients are disproportionately affected by PE, and certain patient and hospital factors are associated with hospitalization decisions.

In-hospital outcomes of patients with pancreatic cancer and venous thromboembolism.

e16317 Background: Pancreatic cancer accounts for about 3.2% of all new cancers in the US. It has dismal 5-year relative survival of 11.5% and accounts for 8.2% of all cancer deaths. Studies have shown a strong association of pancreatic cancer with venous thromboembolism (VTE). However, data surrounding outcomes associated with VTE in this population is limited. We aim to estimate the effect of VTE on mortality and healthcare utilization in this population. Methods: We queried the National Inpatient Sample (NIS) 2017-2019 for all adult patients with a diagnosis of pancreatic cancer. The cohort was further classified by the presence of VTE (either acute deep vein thrombosis (DVT) or acute pulmonary embolism (PE)). The primary outcome of interest was in-hospital mortality, and secondary outcomes included hospitalization cost and length of stay, reflecting resource utilization. Multivariable regression analysis was performed to examine the association. Results: Over a period of 3 years, 392,744 admissions were identified with a diagnosis of pancreatic cancer. The mean age was 67 years, and 48% were females. The prevalence of acute DVT and acute PE was 5.0% and 5.8% respectively. In-hospital mortality was roughly 12% in the study cohort who had either DVT or PE. The odds of all-cause mortality were higher in pancreatic cancer admissions complicated by DVT (OR 1.59, 95% CI: 1.34-1.70, p&lt;0.001) or PE (OR 1.39, 95 %CI: 1.23-1.58, p&lt;0.001). The presence of VTE was also associated with higher hospital costs ($17,351 (14,256-20,446, p&lt;0.001) for DVT, and $5,710 (2,679-8,740, p&lt;0.001) for PE and longer hospital stay (7.2 vs 5.7, p&lt;0.001) for DVT and (6.6 vs 5.7, p&lt;0.001) for PE. Conclusions: Our study suggests that the presence of VTE portends poor outcomes in patients with pancreatic cancer. They also increase healthcare expenditure and lead to a longer hospital stay. Current guidelines (2020) recommend against offering thromboprophylaxis to patients with any cancer. Given the worse outcomes, this study reflects the need to formulate risk assessment models for the role of primary thromboprophylaxis in pancreatic cancer.

Experience in the treatment of patients with pulmonary embolism using apixaban and ultrasound inhalations of unfractionated heparin

Introduction. Pulmonary embolism (PE) is one of the leading causes of death even in hospitalized patients. The standard treatment results are disappointing. Since 2004, we have tested a new method for the treatment of hemodynamically insignificant PE (own patent RU2224525C1) by using unfractionated heparin (UFH) in ultrasound inhalations with a nebulizer, since 2014 – in combination with apixaban. Aim. To improve the treatment of PE. Materials and methods. The hospital mortality rate of 713 patients of the cardiac intensive care unit with hemodynamically insignificant PE (from January 1, 2002 to December 31, 2017) was studied. Since 2004, patients have received ultrasound UFH (5000 units twice a day). Since 2014, nebulased UFH has been supplemented with the use of apixaban (10 mg twice a day for 7 days and 5 mg twice a day thereafter). Results and discussion. There is a distinct tendency to the PE hospital mortality decrease, coinciding with the nebulased UFH use (illustrated by a diagram). Neither the systemic bleeding nor the heparin-induced thrombocytopenia were observed. Clinical cases show first reduction of perfusion disorders are seeing scintigraphicaly in 7 days. Unlike LMWH UFH is recommended in severe kidney damage and obesity, thus ultrasound technique has advantages in such patients. Conclusions. Nebulased UFH is an available, simple, safe and effective in treatmtnt of hemodynamically insignificant PE, especially with the use of apixaban. A real improvement in lung perfusion takes 1 week, as shown scintigraphically.

C-36 | Comparison of Systemic Thrombolysis and Mechanical Thrombectomy in COVID-19–Related Pulmonary Embolism

Pulmonary embolism (PE) is a complication that can occur in individuals with COVID-19 because of the inherent thrombogenic risk. Systemic thrombolysis and mechanical thrombectomy are treatment modalities employed for PE with hemodynamic instability. Data were extracted from the National Inpatient Sample (NIS) 2020 Database. The NIS was searched for hospitalizations for PE and co-existing COVID infection. Systemic thrombolysis and mechanical thrombectomy were identified using appropriate ICD-10 codes. The primary outcome was inpatient mortality. Secondary outcomes are shown in Figure 1. Multivariable logistic and linear regression analysis was used accordingly to adjust for confounders. STATA software was used for analysis. Of 46,965 patients with PE related to COVID, 1260 received systemic thrombolysis, and 320 had mechanical thrombectomy. The mechanical thrombectomy group had lower odds of inpatient mortality (0.06, 95% CI 0.02 – 0.15, p<0.001), cardiac arrest (0.08, 95% CI 0.01 – 0.52, p=0.008), vasopressor use (0.07, 95% CI 0.02 – 0.25, p<0.001) and acute renal failure (0.27, 95% CI 0.13 – 0.53, p<0.001) compared to systemic thrombolysis group. The odds of intracranial hemorrhage were the same between the two groups (p=0.565). Patients having mechanical thrombectomy had shorter hospital stay (mean difference 3.6 days, p<0.001) and lower hospital charge (mean difference 104,395 USD, p<0.001). Mechanical thrombectomy in COVID-related PE leads to better patient outcomes; especially inpatient mortality, cardiac arrest, vasopressor use, and acute renal failure compared to systemic thrombolysis.

Association of hyponatremia with clinical outcomes in patients admitted with acute pulmonary embolism.

Hyponatremia is associated with negative prognosis in several conditions like Congestive heart failure and acute MI (Myocardial Infarction), but its impact on the outcomes in patients with pulmonary embolism (PE) is not well studied. We aimed to study the association of hyponatremia in patients hospitalized with PE. A retrospective cohort study was designed using data obtained from the 2016 to 2019 combined National Inpatient Sample (NIS) database. Adult patients admitted with PE were identified and stratified based on the presence of hyponatremia. Primary outcomes assessed were, mortality, length of stay (LOS), and Total Hospitalization Charges (THC). Secondary outcomes included a diagnosis of Acute Kidney Injury (AKI), Acute Respiratory Failure (ARF), sepsis, Acute Cerebrovascular accident (CVA), arrhythmias and acute MI. Multivariate linear and logistic regressions were used to adjust for confounders. There was a total of 750,655 adult hospitalizations for PE and among them 41,595 (5.5%) had a secondary diagnosis of hyponatremia. Hyponatremia was associated with an increased odds of mortality, 6.31% vs 2.91% (AOR:1.77, p = 0.000, 95% CI: 1.61-1.92), increased LOS, 6.79days vs 4.20days (adjusted difference of 2.20days, p = 0.000, 95% CI: 2.04-2.37), as well as an increase in THC, 75,458.95 USD vs 46,708.27 USD (adjusted difference of 24,341.37 USD, p < 0.001, 95% CI: 21,484.58-27,198.16). Similarly, the presence of hyponatremia was associated with increased odds of several secondary outcomes measured. Hyponatremia is associated with an increased odds of death and attendant increase in LOS and THC. The odds of several secondary adverse clinical outcomes were also increased.

Outcomes with catheter-directed thrombolysis vs. catheter-directed embolectomy among patients with high-risk pulmonary embolism: a nationwide analysis.

To examine the shot-term outcomes with catheter-directed thrombolysis (CDT) vs. catheter-directed embolectomy (CDE) for high-risk pulmonary embolism (PE). The Nationwide Readmissions Database was utilized to identify hospitalizations with high-risk PE undergoing CDE or CDT from 2016 to 2019. The main outcome was all-cause in-hospital mortality. Propensity score matching was used to compare the outcomes in both groups. Among 3216 high-risk PE hospitalizations undergoing catheter-directed interventions, 868 (27%) received CDE, 1864 (58%) received CDT, and 484 (15%) received both procedures. In the unadjusted analysis, the rate of all-cause in-hospital mortality was not different between CDE and CDT (39.6% vs. 34.2%, P = 0.07). After propensity score matching, there was no difference in the incidence of in-hospital mortality [adjusted odds ratio (aOR): 1.28, 95% confidence interval (CI): 0.95, 1.72, P = 0.10], intracranial haemorrhage (ICH) (adjusted OR 1.57, 95% CI: 0.75, 3.29, P = 0.23), or non-ICH bleeding (aOR: 1.17, 95% CI: 0.85, 1.62, P = 0.33). There were no differences in the length of stay, cost, and 30-day unplanned readmissions between both groups. In this contemporary observational analysis of patients admitted with high-risk PE undergoing CDT or CDE, the rates of in-hospital mortality, ICH, and non-ICH bleeding events were not different.

Computed Tomography Angiography for Detection of Pulmonary Embolism in Western Australia Shows Increasing Use with Decreasing Diagnostic Yield.

(1) Background: Pulmonary embolism (PE) can be fatal. Computed tomography pulmonary angiography (CTPA) can accurately diagnose PE, but it should be used only when reasonable pre-test probability exists. Overtesting with CTPA exposes patients to excess ionizing radiation and contrast media, while PE overdiagnosis leads to the treatment of small emboli unlikely to cause harm. This study assessed trends in CTPA use and diagnostic yield. We also assessed trends in PE hospitalizations and mortality to indicate PE severity. (2) Methods: Analysis of Western Australian linked administrative data for 2003-2015 including hospitalizations, emergency department (ED) attendances, and CTPA performed at hospitals. Age-sex standardized trends were calculated for CTPA use, PE hospitalizations, and mortality (as a proxy for severity). Logistic regression assessed diagnostic yield of CTPA following unplanned ED presentations. (3) Results: CTPA use increased from 3.3 per 10,000 person-years in 2003 (95% CI 3.0-3.6) to 17.1 per 10,000 person-years (16.5-17.7) in 2015. Diagnostic yield of CTPA increased from 12.7% in 2003 to 17.4% in 2005, declining to 12.2% in 2015 (p = 0.049). PE hospitalizations increased from 3.8 per 10,000 (3.5-4.1) in 2003 to 5.2 per 10,000 (4.8-5.5) in 2015. Mortality remained constant at 0.50 per 10,000 (0.39-0.62) in 2003 and 0.42 per 10,000 (0.32-0.51) in 2015. (4) Conclusions: CTPA increased from 2003 to 2015, while diagnostic yield decreased, potentially indicating overtesting. PE mortality remained constant despite increasing hospitalizations, likely indicating a higher proportion of less severe cases. As treatment can be harmful, this could represent overdiagnosis.

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.

COVID-19 infection and its impact on case-fatality in patients with pulmonary embolism

Abstract Background Although a high prevalence of pulmonary embolism (PE) has been reported as a complication during severe COVID-19 infections in critical ill patients, nationwide data of hospitalized patients with COVID-19 with PE is still limited. Thus, we sought to analyze seasonal trends and predictors of in-hospital case-fatality in patients with COVID-19 and PE in Germany. Methods We used the German nationwide inpatient sample to analyze all data on hospitalizations for COVID-19 patients with and without PE in Germany during the year 2020 and to compare changes of PE prevalence to 2019. Results We analyzed data of 176,137 hospitalizations because of COVID-19 in 2020. Among those, PE was recorded in 1.9% (n=3,362) of discharge or death certificates. Almost one third of patients with COVID-19 and PE died during the in-hospital course (28.7%). The case-fatality rate increased with patients' age peaking in the 9th life-decade. Regardless of COVID-19, 196,203 inpatients were diagnosed with PE in Germany between 2019 and 2020. The number of PE hospitalizations were widely equally distributed between both years (98,485 vs. 97,718), while the case-fatality rate of all patients with PE was slightly lower in 2019 compared to 2020 (12.7% vs. 13.1%, P&amp;lt;0.001). In contrast, considerable differences in prevalence and case-fatality were demonstrated in 2020 regarding PE patients with and without COVID-19 infection (28.7% vs. 13.1%, P&amp;lt;0.001) (Figure 1). A COVID-19-infection was associated with a 2.8-fold increased risk of case-fatality in patients with PE (OR 2.81, 95% CI 1.66–2.12, P&amp;lt;0.001). Conclusions In Germany, the prevalence of PE events complicating hospitalizations was similar in 2019 and 2020. However, the fatality rate among patients with COVID-19-associated PE was substantially higher than that in those without either COVID-19 or PE, indicating an additive prognostic effect of these two conditions. Funding Acknowledgement Type of funding sources: None.

In-hospital prognosis of malignancy-related pulmonary embolism: an analysis of the national inpatient sample 2016-2018.

A substantial proportion of patients with malignancy develop pulmonary embolism (PE), which significantly worsens the prognosis and ranks as one of the leading causes of mortality in these patients. This retrospective study aimed to examine prognosis of PE in 17 different types of malignancies. All hospitalizations for a primary diagnosis of PE, were identified from the National Inpatient Sample from 2016 to 2018 and divided into those with and without malignancies. Propensity score matching was performed with malignancy as the dependent variable and 23 clinically relevant covariates. Malignancy was stratified into 17 different types of cancer, for which the odds of in-hospital mortality were calculated. After propensity score matching, 82,970 hospitalizations for PE each were allocated into those with and without malignancy groups. PE in all types of malignancies had significantly higher odds of in-hospital mortality compared to PE without malignancy (OR 2.27, 95% CI 2.03-2.54). When stratified to types, esophageal cancer (OR 4.05, 95% CI 2.77-5.92) was associated with the highest odds of in-hospital mortality, followed by gastric (OR 3.41, 95% CI 2.25-5.16) and ovarian cancer (OR 2.95, 95% CI 2.12-4.13). On sensitivity analysis, only PE in esophageal and lung cancer was associated with higher odds of in-hospital mortality compared to PE in all other malignancies combined. Hospitalizations for PE in patients with malignancy were associated with higher odds of in-hospital mortality than those without malignancy. Esophageal cancer had the highest odds of in-hospital mortality, followed by gastric, ovarian, and lung cancer.

Hospitalizations for pulmonary embolism in Brazil (2008-2019): an ecological and time series study.

ABSTRACTObjectiveTo assess the temporal trends of hospitalizations for pulmonary embolism (PE) in Brazil, its regions, and states between 2008 and 2019.MethodsAn ecological and time series study was conducted. Data were obtained from the Hospital Information System (SIH) of the Brazilian Ministry of Health. The inflection point regression model was applied for temporal trend analyses. Trends were classified as increasing, decreasing, or stationary according to the slope of the regression line. The Annual Percent Charge (APC) and the Average Annual Percent Change (AAPC) were calculated considering a confidence interval of 95% and p-value <0.05. Furthermore, spatial distribution maps of epidemiological indicators related to PE in Brazil were elaborated.ResultsThere was an increasing trend in the hospitalization rate for PE in Brazil, ranging from 2.57 in 2008 to 4.44/100,000 in 2019 (AAPC=5.6%; p<0.001). Total and average hospitalizations costs also showed increasing trend in the country (AAPC=9.2% and 3.0%, respectively). Still, there was a decrease in the in-hospital mortality rate (from 21.21% to 17.11%; AAPC=-1.9%; p<0.001). Similar trends were observed in most regions. The average hospitalization time in Brazil showed a stationary trend. The hospitalization rate has also increased in 18 states (66.67%). Seven states showed a decrease in the mortality rate (25.93%), except for Roraima, which showed an increasing trend.ConclusionHospitalizations for PE represent a serious public health problem in Brazil and the temporal patterns observed herein demonstrate an increasing trend in all regions and states of the country.

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.