Survival on the rise among high-risk pulmonary embolism patients
In-hospital mortality is improving among high-risk pulmonary embolism (PE) patients, according to new findings published in the American Journal of Cardiology.[1] Systemic thrombolysis (ST) and catheter-directed interventions, researchers noted, are both playing key roles in patient care.
The new analysis focused on data from the Nationwide Readmissions Database, including more than 1.4 million patients hospitalized for acute PE from 2016 to 2019. A total of 2.4% of these patients were admitted with high-risk PE, meaning they were in cardiogenic shock or received vasopressors. Patients were excluded from the study if mortality data could not be confirmed.
Overall, the study’s authors found that in-hospital mortality was 6.5% among all patients hospitalized for PE. Among high-risk PE patients, meanwhile, in-hospital mortality was 42.3%, though it did decrease from 48.1% in early 2016 to 38.9% in late 2019.
Readmission after 30 days, meanwhile, was see in 15.2% of all patients and 19.1% of high-risk PE patients.
More and more pulmonary embolism patients are being treated with systemic thrombolysis and catheter-directed interventions
Looking at all hospital admissions for PE, 2.5% of patients underwent a catheter-directed intervention such as catheter-directed thrombolysis (CDT) or catheter-directed embolectomy (CDE), 2.1% of patients received ST and 0.2% underwent surgical embolectomy (SE).
For patients with high-risk PE, those rates were 11.3% for ST, 6.6% for catheter-directed interventions and 3% for SE.
Both ST and catheter-directed intervention utilization increased over the course of the study. ST remains the go-to treatment option for high-risk patients, and by a significant margin, but catheters became the No. 1 option for all PE patients by the middle of 2017.
Pulmonary embolism response teams, patient management playing an important role
One potential reason for the increased use of catheter-directed interventions such as CDT and CDE is the increasing popularity of pulmonary embolism response teams (PERTs).
“Multidisciplinary PERTs were introduced in 2013,” wrote first author Ramy Sedhom, MD, MS, of the department of medicine at Albert Einstein Medical Center in Philadelphia, and colleagues. “These teams are composed of experts from different specialties aiming at providing better care to patients with high-risk PE in a timely manner. They help in rapid risk stratification of patients and choosing the most appropriate management strategy.”
Other aspects of patient management may also be making an impact. For instance, the authors noted, physicians treating shock are now more likely to turn to mechanical circulatory support now than they were in the past.
Sedhom et al. also wrote that the risk of intracranial hemorrhage was lower among (0.6%) catheter-directed intervention patients than ST patients (1.8%).
“By delivering lower doses of thrombolytics directly into the pulmonary arteries, the risk of major bleeding, including ICH, is expected to be lower with CDT,” they wrote, calling for additional research that examines this trend among PE patients.
Related Pulmonary Embolism Coverage
VIDEO: Cardiology getting more involved in pulmonary embolism response teams
VIDEO: What interventional cardiologists need to perform pulmonary embolism thrombectomy
Find more pulmonary embolism content
Reference:
Michael has more than 18 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.