Differences in Clinical Presentation of Pulmonary Embolism in Older vs Younger Patients

Abstract

ulmonary embolism (PE) is a major health problem associated with a significant morbidity and mortality particularly in older patients. The overall annual incidence is approximately more than 1 case per 1,000 person-years, 1 but this increases markedly with advancing age. [1][2][3][4] The incidence is distributed extremely unevenly over the ages: 1 case per 1,000,000 person-years for children aged less than 15 years, 72.4 cases per 100,000 person-years for adults aged 40-54 years and 2.8 cases per 1,000 personyears for those aged 85-89 years. 2,3,5 Autopsy series have shown that PE is responsible for, or at least accompanies, approximately 12% of inhospital deaths and this rate increases to 20% for the patients aged 70 years and over. 6,7 Kniffin et al reported a 1-year mortality for PE of 39% in patients older than 65 years, 3 and Sakuma et al reported that the relative risk of mortality from PE was 417.76 for the patients aged over 79 years. 8 The high incidence of PE requires physicians to maintain a high level of suspicion in order to make a prompt diagnosis and initiate appropriate treatment, which is even more important for elderly patients who have higher mortality rates. On the other hand, physicians have to deal with the challenge of diagnosing suspected PE in elderly because older patients with PE may present with atypical clinical features in the absence of the usual indices. However, the clinical presentation of PE in the elderly population has not been extensively investigated. In the present study, the Circulation Journal Vol.69, August 2005hospital records of patients with documented PE were analyzed according to age, and risk factors, presenting symptoms and signs, arterial blood gas (ABG) analysis, electrocardiographic (ECG) and echocardiographic (ECHO) findings and, pulmonary vascular obstruction scores (PVOs) as a marker of severity of the disease, were compared for a better definition of the disease characteristics in the older population. Methods Study Population and DesignThe study was carried out at Gazi University, a large teaching hospital in Ankara. Hospital records between 1998 to 2003 from the Chest Department's database were used to identify patients who had received a final diagnosis of PE, which was established according to the protocol previously published by Prospective Investigation of Pulmonary Embolism Diagnosis investigators. 9 Patients diagnosed with pneumonia were not included in the study.Patients who met the entry criteria were stratified into 2 groups as older (≥65 years old) or younger (<65 years old) patients. The risk factors for PE were defined as follows: 10,11 immobilization (at least 2 days' bed rest in the 2 weeks prior to admission), pregnancy (includes postpartum period within the 3 months prior to admission), estrogen or oral contraceptive use, stroke, obesity (body mass index >27 kg/m 2 ), trauma (within past 3 months), recent operation (within past 6 weeks), malignancy, recent history of long travel (>6 h within 1 week), chronic obstructive lung disease (COPD...

Incidence and Clinical Predictors of Deep Vein Thrombosis in Patients Hospitalized With Heart Failure in Japan

“…28 If the patient had a new symptom of suspected PTE (dyspnea, pleuritic chest pain, hemoptysis, syncope or cough), ventilation/perfusion lung scintigraphy, enhanced CT or pulmonary angiography was performed to rule out PTE. 29,30 The incidence of DVT was evaluated by venous ultrasonography based on the severity of CHF, medication with/ without antiplatelet or anticoagulation therapy, body mass index (BMI), and length of hospital stay and bed rest until venous ultrasonography. Other VTE risk factors such as prior VTE, recent surgery, fracture, trauma, malignancy, nephrotic syndrome, and paralysis were also evaluated.…”

Prognostic Significance of Inverted T Waves in Patients With Acute Pulmonary Embolism

“…19,20 The diagnosis of acute PE was confirmed by pulmonary angiography, lung perfusion scintigraphy or spiral computed tomographic scanning. PE was confirmed using pulmonary arterial angiography in 30 patients (75%), lung perfusion scintigraphy in 31 patients (78%) and CT scan in 26 patients (65%).…”

Diagnosis and management of pulmonary embolism in the elderly

“…Whereas typical symptoms and signs suggestive of PE are found in the majority of patients with PE who do not have pre-existing cardiac or pulmonary diseases [5], this is not the case for elderly patients. In small retrospective series of elderly patients with confirmed PE, clinical presentation is shown to differ from younger patients, syncope being more often present [6][7][8] whereas pleuritic chest pain is consistently less frequently reported than in younger patients [8][9][10].…”