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J Am Coll Cardiol. 2016 Jan 19;67(2):162-170. doi: 10.1016/j.jacc.2015.10.060.

Trends in the Management and Outcomes of Acute Pulmonary Embolism: Analysis From the RIETE Registry.

Author information

1
Respiratory Department, Ramón y Cajal Hospital and Instituto Ramón y Cajal de Investigación Sanitaria IRYCIS, Madrid, Spain. Electronic address: djimenez.hrc@gmail.com.
2
Respiratory Department, Hospital Universitario Gregorio Marañón, Madrid, Spain.
3
Internal Medicine Department, Biomedical Institute of Malaga (IBIMA), Hospital Regional Universitario de Malaga, Malaga, Spain.
4
Medicine Department, Santa Lucía Hospital, Cartagena, Murcia, Spain.
5
Respiratory Department, Virgen del Rocío Hospital and Instituto de Biomedicina, Sevilla, and CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain.
6
Medicine Department, Hospital Rey Juan Carlos, Móstoles, Spain.
7
Biostatistics Department, Ramón y Cajal Hospital and Instituto Ramón y Cajal de Investigación Sanitaria IRYCIS, CIBERESP, Madrid, Spain.
8
Université Paris Descartes, Sorbonne Paris Cité, and Division of Respiratory and Intensive Care Medicine, Hôpital Européen Georges Pompidou, AP-HP, Paris, France.
9
Divisions of Pulmonary and Critical Care Medicine and General Medical Sciences, Washington University School of Medicine, St. Louis, Missouri.
10
Department of Internal Medicine, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, and Universidad Católica de Murcia, Murcia, Spain.

Abstract

BACKGROUND:

Despite advances in hospital management in recent years, it is not clear whether mortality after acute pulmonary embolism (PE) has decreased over time.

OBJECTIVES:

This study describes the trends in the management and outcomes of acute symptomatic PE.

METHODS:

We identified adults with acute PE enrolled in the registry between 2001 and 2013. We assessed temporal trends in length of hospital stay and use of pharmacological and interventional therapies. Using multivariable regression, we examined temporal trends in risk-adjusted rates of all-cause and PE-related death to 30 days after diagnosis.

RESULTS:

Among 23,858 patients with PE, mean length of stay decreased from 13.6 to 9.3 days over time (32% relative reduction, p < 0.001). For initial treatment, use of low-molecular-weight heparin increased from 77% to 84%, whereas the use of unfractionated heparin decreased from 22% to 8.4% (p < 0.001 for trend for all comparisons). Thrombolytic therapy use increased from 0.7% to 1.0% (p = 0.07 for trend) and surgical embolectomy use doubled from 0.3% to 0.6% (p < 0.01 for trend). Risk-adjusted rates of all-cause mortality decreased from 6.6% in the first period (2001 to 2005) to 4.9% in the last period (2010 to 2013) (p = 0.02 for trend). Rates of PE-related mortality decreased over time, with a risk-adjusted rate of 3.3% in 2001 to 2005 and 1.8% in 2010 to 2013 (p < 0.01 for trend).

CONCLUSIONS:

In a large international registry of patients with PE, improvements in length of stay and changes in the initial treatment were accompanied by a reduction in short-term all-cause and PE-specific mortality.

KEYWORDS:

heparin; length of stay; outcomes; prognosis; surgical embolectomy; survival; thrombolysis

PMID:
26791063
DOI:
10.1016/j.jacc.2015.10.060
[Indexed for MEDLINE]
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