Short‐term outcomes of pulmonary embolism: A National Perspective

Shah, Prithvi; Arora, Shilpkumar; Kumar, Varun; Sharma, Surina; Shah, Harshil; Sharma, Purnima; Sharma, Ravina; Savani, Sejal; Qureshi, Muhammad Raheel; Faruqi, Ibrahim

doi:10.1002/clc.23048

Cited by 11 publications

(15 citation statements)

References 29 publications

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“…8 Cardiovascular events after acute PE are common, and the presence of HF enhances the possibility of PE recurrence and all-cause death. 4,5 However, the pathophysiology of HFrEF and HFpEF is different and it is unknown whether these two basic types of HF have a diverse impact on PE outcome.…”

Section: Introductionmentioning

confidence: 99%

“…However, patients with HFrEF die more frequently from cardiovascular reasons, while patients with HFpEF die mostly from some other non‐cardiovascular diseases 8 . Cardiovascular events after acute PE are common, and the presence of HF enhances the possibility of PE recurrence and all‐cause death 4,5 . However, the pathophysiology of HFrEF and HFpEF is different and it is unknown whether these two basic types of HF have a diverse impact on PE outcome.…”

Section: Introductionmentioning

confidence: 99%

“…[1][2][3] Patients with HF are more prone to develop acute PE and have a worse short-term and long-term prognosis after PE. [4][5][6] Regarding the level of left ventricle (LV) ejection fraction (LVEF) and according to current European Society of Cardiology (ESC) guidelines, HF patients are classified into the three different groups, such as the one with HF with reduced ejection fraction (HFrEF) (LVEF < 40%), then those with HF with middle-range ejection fraction (HFmrEF) (LVEF 40-49%), and those with HF with preserved ejection fraction (HFpEF) (LVEF ≥ 50%). 7 In patients with HFrEF, both systolic and diastolic myocardial functions are impaired, while in patients with HFpEF, diastolic dysfunction predominates.…”

Section: Introductionmentioning

confidence: 99%

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Predictive value of heart failure with reduced versus preserved ejection fraction for outcome in pulmonary embolism

et al. 2020

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Aims This study aimed to investigate whether the risk of short-term mortality is different in pulmonary embolism (PE) patients who have heart failure with reduced ejection fraction (HFrEF) as compared with those with heart failure with preserved ejection fraction (HFpEF). Methods and results Predictive value of HFrEF or HFpEF for 7-day (intrahospital) and 30-day all-cause mortality was determined in the cohort of 1055 out of 1201 consecutive acute PE patients from the Serbian multicentre PE registry. Patients were classified into either HFrEF or HFpEF group, according to guideline-proposed criteria. A 7-day (intrahospital) and 30-day all-cause mortality was 18.5% vs. 7.3% vs. 4.5% (P < 0.001) and 22.2% vs. 16.3% vs. 7.9% (P < 0.001) for patients with the history of HFrEF, HFpEF, and without HF, respectively. Multivariable analysis adjusted to age, gender, history of chronic obstructive pulmonary disease, diabetes mellitus, arterial hypertension, presence of atrial fibrillation, and mortality risk assessment at admission has shown that only HFrEF, but not HFpEF, was an independent predictor for 7-day mortality (hazard ratio 2.22, 95% confidence interval 1.25-4,38.41, P = 0.021) and neither HFrEF or HFpEF was an independent predictor for 30-day mortality. Among various admission parameters associated to PE outcome, only systolic pressure in HFrEF patients (P < 0.001), heart rate (P = 0.01), and right ventricle systolic pressure (P = 0.039) in HFpEF patients were significantly different in patients who died compared with those who survived at 7 days. Conclusions Our study has shown that the presence of previous history of HFrEF, but not HFpEF, in acute PE is an independent risk factor for mortality at 7 days.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Predictive value of heart failure with reduced versus preserved ejection fraction for outcome in pulmonary embolism

et al. 2020

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“…Of those clinical studies, comorbidities, including cancer, chronic lung disease, congestive heart failure, were found to be related to adverse outcomes in patients with acute PE. 17 - 19 Patients with congestive heart failure usually have RV dysfunction and this situation worsens with the addition of acute PE. In our study, congestive heart failure was related to high mortality in intermediate-high risk patients with Acute PE-related, which supported this finding.…”

Section: Discussionmentioning

confidence: 99%

In-hospital and short-term predictors of mortality in patients with intermediate-high risk pulmonary embolism

Gök¹,

Karadağ²,

Çınar³

et al. 2020

J Cardiovasc Thorac Res

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Introduction: The aim of this study was to evaluate the in-hospital and short-term predictive factors of mortality in intermediate-high risk acute pulmonary embolism (PE) patients with right ventricle (RV)dysfunction and myocardial injury. Methods: In this retrospective study, the medical records of 187 patients with a diagnosis of intermediate high risk acute PE were evaluated. A contrast-enhanced multi-detector pulmonary angiography was used to confirm diagnosis in all cases. All-cause mortality was determined by obtaining both in hospital and 30 days follow-up data of patients from medical records. Results: During the in-hospital stay (9.5±4.72 days), 7 patients died, resulting in an acute PE related in-hospital mortality of 3.2%. Admission heart rate (HR), (Odds ratio (OR), 1.028 95% Confidence interval (CI), 0.002-1.121; P = 0.048) and blood urea nitrogen (BUN) (OR, 1.028 95% CI, 0.002-1.016; P = 0.044) were found to be independent predictors for in-hospital mortality in a multi variate logistic regression analysis. In total, 32 patients (20.9%) died during 30 days follow-up.The presence of congestive heart failure (OR, 0.015, 95%CI, 0.001-0.211; P = 0.002) and dementia (OR, 0.029, 95%CI,0.002-0.516; P = 0.016) as well as low albumin level (OR, 0.049 95%CI, 0.006-0.383; P = 0.049) were associated with 30 days mortality. Conclusion: HR and BUN were independent predictors of in-hospital mortality and the presence of congestive heart failure, dementia, and low albumin levels were associated with higher 30 days mortality.

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“…Heart failure, COPD, anemia, and malignancy were associated with a higher readmission and 90-day mortality rate. 53 Early complications (2 weeks-6 months) can occur as recurrent PE. It is co-related with underlying co-morbidities like malignancy or failure to achieve therapeutic levels of oral anticoagulation.…”

Section: Prognosismentioning

confidence: 99%

Acute Pulmonary Embolism: Contemporary Approach to Diagnosis, Risk-Stratification, and Management

et al. 2019

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Pulmonary embolism (PE) affects over 300,000 individuals each year in the United States and is associated with substantial morbidity and mortality. Improvements in the diagnostic performance and availability of computed tomographic pulmonary angiography and D-dimer testing have facilitated the evaluation of patients with suspected PE. High clinical suspicion is required in those with risk factors and/or those that manifest signs or symptoms of venous thromboembolic disease, with validated clinical risk scores such as the Wells and modified Wells score or the PE rule-out criteria helpful in estimating the likelihood for PE. For those with confirmed PE, patients should be categorized and triaged according to the presence or absence of shock or hypotension. Normotensive patients can be further risk-stratified using validated prognostic risk scores, as well as by using imaging and cardiac biomarkers, with those having either signs of right ventricular dysfunction on imaging studies and/or abnormal cardiac biomarkers categorized as being at intermediate-risk and requiring close monitoring and hospital admission. Early discharge and/or home therapy are possible in those that do not manifest any high-risk features. The initial treatment for most patients that are stable consists of anticoagulation, with advanced therapies such as thrombolysis, catheter-based therapies, or surgical embolectomy deferred for those at high risk. Given the heterogeneous presentations of PE and various management strategies available, the development of multidisciplinary PE response teams has emerged to help facilitate decision-making in these patients.

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Short‐term outcomes of pulmonary embolism: A National Perspective

Abstract: Older female patients were more likely to have a pulmonary embolism. High-risk groups such as heart failure, chronic pulmonary disease, anemia, and malignancy need to be given extra attention to prevent worse outcomes.

Cited by 11 publications

References 29 publications

Predictive value of heart failure with reduced versus preserved ejection fraction for outcome in pulmonary embolism

Predictive value of heart failure with reduced versus preserved ejection fraction for outcome in pulmonary embolism

In-hospital and short-term predictors of mortality in patients with intermediate-high risk pulmonary embolism

Acute Pulmonary Embolism: Contemporary Approach to Diagnosis, Risk-Stratification, and Management

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