A Comparison of Patients Diagnosed With Pulmonary Embolism Who Are ≥65 Years With Patients <65 Years
| Autor: | Christopher Kabrhel, Beau M. Hawkins, Ido Weinberg, Blair A. Parry, Praveen Hariharan, Ikenna Okechukwu, Michael R. Jaff, Rachel P. Rosovsky, Shan W. Liu, Philip Cefalo, Yuchiao Chang |
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| Rok vydání: | 2015 |
| Předmět: |
Adult
Male Pediatrics medicine.medical_specialty Vena Cava Filters MEDLINE Logistic regression Risk Assessment Cohort Studies Older patients Internal medicine medicine Humans Thrombolytic Therapy Intensive care medicine Aged Aged 80 and over business.industry Age Factors Anticoagulants Emergency department Middle Aged medicine.disease Pulmonary embolism Cardiology Female Observational study Emergency Service Hospital Pulmonary Embolism Cardiology and Cardiovascular Medicine Risk assessment business Cohort study |
| Zdroj: | The American Journal of Cardiology. 115:681-686 |
| ISSN: | 0002-9149 |
| Popis: | Recent studies have highlighted differences in how older patients respond to high-risk pulmonary embolism (PE) and treatment. However, guidelines for PE risk stratification and treatment are not based on age, and data are lacking for older patients. We characterized the impact of age on clinical features, risk stratification, treatment, and outcomes in a sample of patients with PE in the emergency department. We performed an observational cohort study of 547 consecutive patients with PE in the emergency department from 2005 to 2011 in an urban tertiary hospital. We used bivariate proportions and multivariable logistic regression to compare clinical presentation, risk category, treatment, and outcomes in patients ≥65 years with those65 years. The mean age was 58 ± 17 years, 276 (50%) were women, and 210 (38%) were ≥65 years. PE was more severe in patients ≥65 years (massive 14% vs 5%, submassive 48% vs 25%, and low risk 38% vs 70%, p0.0001), with submassive PE being the most common presentation in patients ≥65 years. However, subanalysis removing natriuretic peptides from the definition of submassive PE negated this finding. Treatment with parenteral anticoagulation (88% vs 90%, p = 0.32), thrombolytic therapy (5% vs 4%, p = 0.87), and inferior vena cava filter (4% vs 4%, p = 0.73) were similar among age groups. Patients ≥65 years had higher 30-day mortality (11% vs 3%, p0.001). In conclusion, patients ≥65 years present with more severe PE and have higher mortality, although treatment patterns were similar to younger patients. Age-specific guideline definitions of submassive PE may better identify high-risk patients. |
| Databáze: | OpenAIRE |
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