Author + information
- Behnood Bikdeli, MD∗ (, )
- Yun Wang, PhD,
- Karl E. Minges, MPH and
- Nihar R. Desai, MD, MPH
- ↵∗Center for Outcomes Research and Evaluation, Yale–New Haven Hospital, Department of Internal Medicine, Yale University School of Medicine, 1 Church Street, Suite 200, New Haven, Connecticut 06510
We read with interest the important contribution by Jiménez et al. (1) regarding recent trends of pulmonary embolism (PE) hospitalizations and outcomes from the Registro Informatizado de Pacientes con Enfermedad TromboEmbólica (RIETE), a large, primarily western European prospective registry of venous thromboembolism. The registry recorded decreased length of hospital stay, as well as decreased rates of adjusted 30-day all-cause mortality rates, from 2001 to 2013.
Similar to the reports of Jiménez et al. (1), our prior investigations of Medicare fee-for-service beneficiaries showed significant reductions in in-hospital, 30-day, and 1-year mortality rates, as well as reduced length of hospital stay and more frequent use of inferior vena cava filters from 1999 to 2010 (2,3). In addition, we noted increased hospitalizations with PE over time (31,746 in 1999 compared with 54,392 in 2010, a relative increase of 71%; p < 0.001). Thrombolytic therapy and thrombectomy (surgical or percutaneous) were similarly rare in our cohort of hospitalizations with a principal discharge diagnosis of PE (Table 1). Moreover, inferior vena cava filters were used in >15% of our cohort of older adults, compared with only 2% to 4% of patients in the study by Jiménez et al.
The higher all-cause 30-day mortality rates in our cohort compared with that of Jiménez et al. (1) is likely related to the older age and greater comorbidity burden for older adults in our study. With regard to the reduced mortality rates over time, although several hypotheses (including some improvement in treatment of PE and averting more cases of fatal PE over time) are possible, we agree with the accompanying editorial that better vigilance and more sensitive diagnostic strategies (primarily driven by the high sensitivity of computed tomography pulmonary angiography) may have led to the detection of emboli that if left untreated would not cause symptoms or death (2,4). In fact, recent guidelines would support deferring anticoagulant therapy in several of these cases (5).
The contributions from both of these bodies of research highlight the most recent evidence of PE trends in 2 large populations and indicate a significant proportion of the global PE burden. Future studies should seek to further elucidate the causes of the observed trends, as well as risk stratification of patients with PE, to enable an optimal balancing of risk and benefit for routine and advanced therapies. This research may be particularly important for the subgroups of patients who would benefit most from each of the routine or advanced PE therapies.
Please note: This study was supported by grant number U01HL105270-05 (Center for Cardiovascular Outcomes Research at Yale University) from the National Heart, Lung, and Blood Institute. The content is solely the responsibility of the authors and does not necessarily represent the official views of the sponsor. The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- American College of Cardiology Foundation
- Jimenez D.,
- de Miguel-Diez J.,
- Guijarro R.,
- et al.
- Bikdeli B.,
- Wang Y.,
- Minges K.E.,
- et al.
- Konstantinides S.V.