PE Admissions Up, but Short-term Mortality Down

Nicola M. Parry, DVM

August 13, 2019

The rate of hospitalization for pulmonary embolization (PE) among older US adults increased during the past 15 years, according to a study published online August 13 in JAMA.

However, at the same time, "LOS [length of stay], readmission rates, and short-term and 1-year mortality rates declined," write Behnood Bikdeli, MD, from Columbia University Medical Center, New York City, and colleagues.

Significant progress in the field of PE during the past 2 decades has led to advances in its diagnosis and management that enable earlier patient discharge.

With this in mind, Bikdeli and colleagues conducted a study to investigate how these advances have affected outcomes in older patients with PE.

They analyzed Medicare fee-for-service claims data from 810,969 patients who had received a principal discharge diagnosis of PE from 1999 through 2015. In particular, the researchers examined hospitalization rates per 100,000 beneficiary-years, LOS, all-cause 30-day readmissions, and all-cause in-hospital, 30-day, and 1-year mortality.

The adjusted PE hospitalization rate rose from 120.0 (95% confidence interval [CI], 120.0 – 120.0) in 1999 to 198.0 (95% CI, 194.4 – 201.6) in 2010, and then fell to 187.2 (95% CI, 184.0 – 190.4) in 2015.

By contrast, LOS decreased during this time, falling from 7.7 days in 1999 to 5.0 days in 2015 (P < .001 for trend).

Similarly, adjusted 30-day readmission rates fell from 15.5% to 13.6% (P = .005), as did adjusted 30-day (from 12.7% to 9.4%) and 1-year (from 26.3% to 24.1%) mortality rates (P < .001 for trend).

Various factors may have contributed to these changes over time, the authors say, such as the use of CT pulmonary angiography for diagnosis, which allows detection of less severe PEs. Other factors include advances that have facilitated more prompt diagnosis and treatment of PE and those that have improved the care of older adults with PE.

"Additional studies are required to determine the reasons behind the observed trends and strategies that may mitigate the residual risk of death or recurrence in older adults," Bikdeli and colleagues conclude.

The study was supported by the National Heart, Lung, and Blood Institute. Several authors have reported relevant financial relationships, which are listed in the original article.

JAMA. Published online August 13, 2019. Abstract

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