Trends of Hospitalizations and Complications of Acute Pulmonary Embolism : A Nationwide Study

Background:

Acute pulmonary embolism (PE) ranks as the third most common cardiovascular disease following coronary artery disease and stroke, significantly contributing to the global disease burden. According to the recent Centers for Disease Control and Prevention data, an estimated 60,000-100,000 Americans die from venous thrombosis annually, with many experiencing long-term complications. Given the high morbidity and mortality associated with PE, early recognition and a multidisciplinary management approach are crucial. With advancements in care and the availability of newer anticoagulants and reperfusion strategies, we aimed to analyze the trends in prevalence and outcomes of acute PE hospitalizations in the United States (US) from 2016 to 2020.

Methods:

The National Inpatient Sample database (NIS) was utilized, and data from 2016 to 2020 were reviewed. We included hospitalized individuals aged 18 years or older who were admitted with a primary or secondary diagnosis of PE using the International Classification of Diseases (ICD-10 codes). National estimates of inpatient admissions were obtained using sample weights provided by the NIS, and mortality and morbidity outcomes and trends of PE were studied. Multivariable regression analyses were performed, adjusting for demographics, patient and hospital-level characteristics, and Charlson comorbidity index.

Results:

PE hospitalizations demonstrated a significant decrease in the US from 770,523 in 2016 (27% of total admissions) to 455,762 in 2020 (16% of total admissions) [p < 0.001]. Among PE hospitalizations, the mean age was 62 years, and 51.31% were females [p < 0.001]. Majority of the admitted patients were Whites (71.43%) [p = 0.033]. The primary healthcare payers were Medicare (51.8%) and Medicaid (22%) [p < 0.001]. The most common geographical location was the Southern US (38.3%), followed by the Midwest (24.38%) [p = 1.000]. Most patients were admitted to tertiary care teaching centers (69%) located in urban areas (78%) [p < 0.001]. Mortality of PE was slightly higher in 2020 (8.18%) compared to other years (2016: 6.22%, 2017: 6.32%, 2018: 6.39%, 2019: 6.52%) [p < 0.001]. The trends of the most commonly associated PE complications have shown an increase over the years: acute respiratory distress syndrome (ARDS) (0.6% in 2016, 0.29% in 2017, 0.24% in 2018, 0.28% in 2019, 1.57% in 2020) [p < 0.001], need for mechanical ventilation (0.48% in 2016, 0.6% in 2017, 0.58% in 2018, 0.6% in 2019, 0.73% in 2020) [p < 0.001], frailty (0.15% in 2016, 0.16% in 2017, 0.18% in 2018, 0.29% in 2019, 0.32% in 2020) [p < 0.001], pleural effusion (8.6% in 2016, 8.72% in 2017, 8.95% in 2018, 9.29% in 2019, 8.74% in 2020) [p = 0.006], arrhythmias (19.6% in 2016, 19.9% in 2017, 20.76% in 2018, 21.14% in 2019, 21.32% in 2020) [p < 0.001], cardiac arrest (2.29% in 2016, 2.45% in 2017, 2.48% in 2018, 2.40% in 2019, 2.90% in 2020) [p<0.001]. Multivariable regression analysis showed a statistically significant increase in various outcomes in 2020 compared to 2016 as evidenced by mortality [OR: 1.04, CI: 1.03-1.06, p < 0.001], ARDS [OR: 1.30, CI: 1.24-1.35, p < 0.001], ventilator need [OR: 1.05, CI: 1.02-1.09, p = 0.002], frailty [OR: 1.24, CI: 1.17-1.31, p < 0.001], pleural effusion [OR: 1.014, CI: 1.004-1.024, p = 0.005], arrhythmia [OR: 1.09, CI: 1.01-1.14, p = 0.016] and cardiac arrest [OR: 1.048, CI: 1.032-0.064, p<0.001].

Conclusion:

The number of PE hospitalizations decreased from 2016 to 2020. Even after significant advancements in hospital care, the mortality and morbidity from PE complications have been significantly uptrending over the years. Further prospective studies are imperative to investigate the rising prevalence of adverse outcomes despite the decreasing incidence of PE. These efforts are pivotal for optimizing patient care and improving healthcare quality.

No relevant conflicts of interest to declare.