Impact of COVID-19 and lockdowns on pulmonary embolism in hospitalized patients in France: a nationwide study

Abstract

Background This study assessed the impact of the COVID-19 epidemic on overall hospitalizations for pulmonary embolism (PE) in France in comparison with previous years, and by COVID-19 and non-COVID-19 status. Methods Hospitalization data (2017–2020) were extracted from the French National Discharge database (all public and private hospitals). We included all patients older than 18 years hospitalized during the 3 years and extracted PE status and COVID-19 status (from March 2020). Age, sex and risk factors for PE (such as obesity, cancer) were identified. We also extracted transfer to an intensive care unit (ICU) and hospital death. The number of PE and the frequency of death in patients in 2019 and 2020 were described by month and by COVID-19 status. Logistic regressions were performed to identify the role of COVID-19 among other risk factors for PE in hospitalized patients. Results The overall number of patients hospitalized with PE increased by about 16% in 2020 compared with 2019, and mortality also increased to 10.3% (+ 1.2%). These increases were mostly linked to COVID-19 waves, which were associated with PE hospitalization in COVID-19 patients (PE frequency was 3.7%; 2.8% in non-ICU and 8.8% in ICU). The final PE odds ratio for COVID-19 hospitalized patients was 4 compared with other hospitalized patients in 2020. The analyses of PE in non-COVID-19 patients showed a 2.7% increase in 2020 compared with the previous three years. Conclusion In 2020, the overall number of patients hospitalized with PE in France increased compared to the previous three years despite a considerable decrease in scheduled hospitalizations. Nevertheless, proactive public policy focused on the prevention of PE in all patients should be encouraged.

Deaths related to pulmonary embolism and cardiovascular events before and during the 2020 COVID-19 pandemic: An epidemiological analysis of data from an Italian high-risk area

“…Notably, pulmonary embolism as cause of death increased also in patients without any mention of COVID-19 in the death certificate. These findings are similar to what reported by French authors concerning national emergency hospitalisations due to pulmonary embolism and in-hospital fatality in 2020 [13] . The recognition (or not) of COVID-19 as the cause of pulmonary embolism may have therapeutic consequences also concerning the length of anticoagulation.…”

“…Furthermore, a broader and more aggressive use of pharmacological preventative measures for venous thromboembolism may have partly reduced this risk, as recently shown by trials conducted in the hospital and ambulatory setting [11] , [12] . One nationwide French study illustrated that the number of pulmonary embolism-related hospitalizations and in-hospital fatality increased in 2020, particularly during the COVID-19 waves [13] .…”

COVID-19 infection and its impact on case-fatality in patients with pulmonary embolism

“…Comparable results were found in Denmark, but were in contrast to findings from Spain, which found no difference between the groups [18]. Those differences might be explained by larger, unselected data set of nationwide data in Denmark and in our study [37]. In general, the higher rate of case-fatality in PE patients with COVID-19 have to be considered in the context of the haemodynamic effect of systemic inflammation.…”

“…In this context, also numbers of PE-related deaths increased during the pandemic in several countries [6,37,38]. Our findings from Germany revealed no increase in the prevalence of PE between 2019 and 2020, but we did observe a slightly higher casefatality of PE in 2020 with seasonal characteristics following the pandemic waves; this is opposing to reports of Italy or France, but in line with nationwide data from Denmark [6,37,39]. However, considering PE patients with COVID-19-infection, case-fatality was dramatically increased in comparison to PE patients without COVID-19 infection.…”

Change in incidence of cardiovascular diseases during the covid-19 pandemic and vaccination campaign: data from the nationwide French hospital discharge database

“…A French nationwide study reported an increased number of patients hospitalized with pulmonary embolism in 2020, mainly linked to the covid-19 waves, in both patients with and without covid-19. 32 This increase was also observed in the United Kingdom, 33 but not in Denmark. 34 In the present study, the difference between the 2021 and 2020 periods mainly occurred in the first five months, and was concentrated in non-covid-19 patients.…”