Circumstances of Hospitalization Impact Outcomes of Pulmonary Embolism.

Autor: Noman A; Department of Medicine, University of Missouri, Kansas City, MO., Gosch K; Saint Luke's Health System, Saint Luke's Mid America Heart Institute, Kansas City, MO., Elkaryoni A; Saint Luke's Health System, Loyola University Medical Center, Maywood, IL., Buckley J; Saint Luke's Health System, Saint Luke's Hospital of Kansas City, Kansas City, MO., Letham O; Department of Medicine, University of Missouri, Kansas City, MO., Fleecs J; Department of Medicine, University of Missouri, Kansas City, MO., Wible BC; Saint Luke's Health System, Saint Luke's Hospital of Kansas City, Kansas City, MO., Bunte MC; Department of Medicine, University of Missouri, Kansas City, MO; Saint Luke's Health System, Saint Luke's Mid America Heart Institute, Kansas City, MO; Saint Luke's Health System, Saint Luke's Hospital of Kansas City, Kansas City, MO. Electronic address: mbunte@saintlukeskc.org.
Jazyk: angličtina
Zdroj: Current problems in cardiology [Curr Probl Cardiol] 2023 Sep; Vol. 48 (9), pp. 101773. Date of Electronic Publication: 2023 May 09.
DOI: 10.1016/j.cpcardiol.2023.101773
Abstrakt: Clinical tools that stratify risk of acute pulmonary embolism (PE) are useful in guiding therapeutic decision making, although may neglect pragmatic and potentially impactful characteristics of hospitalization during care of venous thromboembolism (VTE). Using a retrospective cohort design, consecutive patients discharged after inpatient care for acute PE were retrospectively evaluated for features of hospitalization, including patient characteristics, treatment efficiency, and circumstances of hospitalization. A proportional hazards model incorporated nontraditional risk factors to assess their association with a primary composite endpoint of in-hospital bleeding or death after adjusting for conventional PE risk estimators, including the Pulmonary Artery Severity Index (PESI) and right ventricular/left ventricular (RV/LV) ratio. From January 2016 to December 2018, 822 patients were discharged after treatment for acute PE, including high-risk (5.0%), intermediate-risk (64.2%), and low-risk (30.8%) PE. In-hospital death was 10-fold higher among those with high-risk PE compared to intermediate risk PE (36.6% vs 3.0%, P < 0.001). Overall, 60.4% of hospitalizations were primarily attributed to presentation with VTE. High risk PE was observed more frequently as a secondary event during hospitalizations ostensibly unrelated to VTE (26.8%). After adjustment for PESI score and RV/LV ratio, hypoalbuminia, IVC filter, and non-VTE hospitalization had strong associations with the primary composite outcome. Along with known markers of risk associated with PE, hypoalbuminia, IVC filter placement, and PE complicating hospitalization for circumstances not primarily related to VTE had strong associations with bleeding and death. These findings highlight the complex circumstances of acute PE care and need to refine practical risks.
Competing Interests: Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Dr. Bunte has received institutional research support and is a consultant to Inari Medical, Inc. None of the other authors have any conflicts to disclose.
(Copyright © 2023 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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