Sex differences in presentation, management, and outcomes among patients hospitalized with acute pulmonary embolism

Abstract

While the presence of gender disparities in cardiovascular disease have been described, there is a paucity of data regarding the impact of sex in acute pulmonary embolism (PE). We identified all patients admitted to a tertiary care hospital with acute PE between August 1, 2012 through July 1, 2018. We stratified the presenting characteristics, management, and outcomes between women and men. Of the 2031 patients admitted with acute PE, 1081 (53.2%) were women. Women were more likely to present with dyspnea (59.8% vs 52.0%, p < 0.001) and less likely to present with hemoptysis (1.9% vs 4.0%, p = 0.01). Women were older (63.8 ± 17.4 years vs 62.3 ± 15.0 years, p = 0.04), but had lower rates of myocardial infarction, liver disease, smoking history, and prior DVT. PE severity was similar between women and men (massive: 4.9% vs 3.6%; submassive: 43.9% vs 41.8%; p = 0.19), yet women were more likely to present with normal right ventricular size on a surface echocardiogram (63.2% vs 54.8%, p = 0.01). In unadjusted analyses, women were less likely to survive to discharge (92.4% vs 94.7%, p = 0.04), but after adjustment, there was no sex-based survival difference. There were no sex differences in the PE-related diagnostic studies performed, use of advanced therapies, or short-term outcomes, before and after adjustment ( p > 0.05 for all). In this large PE cohort from a tertiary care institution, women had different comorbidity profiles and PE presentations compared with men. Despite these differences, there were no sex disparities in PE management or outcomes.

Pulmonary Embolism in Women: A Systematic Review of the Current Literature

“…Despite a higher age-adjusted incidence of PE in men, the patterns of developing PE vary with age among women and men [ 14 , 18 , 19 ]. Studies have suggested that women diagnosed with PE are more likely to be older than men [ 15 , 20 , 21 , 22 ]. In the 4-year study conducted by Choi et al evaluating sex differences in the incidence of PE in hospitalized patients, in patients > 50 years of age, PE was more frequent in women (incidence: 0.15%; 95%CI: 0.11–0.19%) compared to men (incidence: 0.08%; 05%CI: 0.05–0.11%; p < 0.01) [ 23 ].…”

“…The investigators found a small but significant difference in the cumulative 5-year probability of recurrent VTE between the sexes (12.4% in men vs. 10.9% in women; p = 0.0001) [ 26 ]. Of note, despite a higher incidence of recurrent PE and overall age-adjusted incidence of PE, men with acute PE were, irrespective of whether first time or recurrent, were more likely to be taking an antiplatelet medication at the time of presentation [ 20 ].…”

“…As discussed above, increased age is a well-established risk factor for PE in women. Multiple studies have shown that women with PE were more likely to have a diagnosis of rheumatologic disorders (6.1% of women vs. 3.3% of men; p < 0.01) compared to men [ 20 , 27 , 28 , 29 ]. Specifically, systemic lupus erythematosus and rheumatoid arthritis (RA) have been found to be significant risk factors for PE after adjusting for age, sex, and other comorbidities.…”

Sex and survival following pulmonary endarterectomy for chronic thromboembolic pulmonary hypertension: a Scandinavian observational cohort study

“…28 Pribish et al. 25 evaluated an American cohort and found that women with acute PE were more likely to have normal right ventricular (RV) size than men on echocardiography.…”

“…Acute pulmonary embolism (PE) is considered one of the major risk factors for development of CTEPH; approximately 70% of patients with CTEPH had prior venous thromboembolism in a previous study 22 . Sex differences have been investigated in Denmark, Sweden, and the United States, with findings that female sex was slightly more common (52%–53%) in cohorts of studies on the incidence of acute PE 23–25 . Outcomes after acute PE seemed to be similar between the sexes after adjustment for age and comorbidities, but the clinical presentations differed between men and women 25–27 .…”