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CC BY-NC-ND 4.0 · Thromb Haemost 2025; 125(04): 364-375
DOI: 10.1055/a-2402-6192
Stroke, Systemic or Venous Thromboembolism

Time Trends and Excess Mortality Compared to Population Controls after a First-Time Pulmonary Embolism or Deep Vein Thrombosis

Katarina Glise Sandblad 
1   Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
2   Department of Medicine, Geriatrics and Emergency Medicine, Region Västra Götaland, Sahlgrenska University Hospital/Östra, Gothenburg, Sweden
,
Carl Johan Svensson
3   Department of Anaesthesiology and Intensive Care, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
4   Department of Anaesthesiology and Intensive Care, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
,
Kristina Svennerholm
3   Department of Anaesthesiology and Intensive Care, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
4   Department of Anaesthesiology and Intensive Care, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
,
Jacob Philipson
1   Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
2   Department of Medicine, Geriatrics and Emergency Medicine, Region Västra Götaland, Sahlgrenska University Hospital/Östra, Gothenburg, Sweden
,
Aldina Pivodic
5   APNC Sweden, Gothenburg, Sweden
,
Sam Schulman 
6   Department of Medicine and Thrombosis and Atherosclerosis Research Institute, McMaster University, Hamilton, Ontario, Canada
,
Mazdak Tavoly
7   Department of Medicine, Geriatrics and Emergency Medicine, Region Västra Götaland, Sahlgrenska University Hospital/Sahlgrenska, Gothenburg, Sweden
8   Department of Research, Østfold Hospital, Sarpsborg, Norway
› Institutsangaben
Funding This study was supported by the Swedish Heart and Lung Foundation (2022–0216); the Swedish state under the agreement between the Swedish government and the county councils (ALFGBG-965023); the Gothenburg Society of Medicine (GLS-986108); Elsa and Gustav Lindh's Foundation, Sahlgrenska University Hospital Research Foundations (SU-984390), and Emelle Funds. The funding sources were not involved in study design; in the collection, analysis, or interpretation of data; in the writing of the report; or in the decision to submit the article for publication.
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Abstract

Background

Recent data on temporal trends in excess mortality for patients with pulmonary embolism (PE) and deep vein thrombosis (DVT) compared with the general population are scarce.

Methods

A nationwide Swedish register study conducted from 2006 to 2018 including 68,960 PE and 70,949 DVT cases matched with population controls. Poisson regression determined relative risk (RR) for 30-day and 1-year mortality trends while Cox regression determined adjusted hazard ratios (aHRs). A significance level of 0.001 was applied.

Results

In PE cases, both 30-day mortality (12.5% in 2006 to 7.8% in 2018, RR: 0.95 [95% CI: 0.95–0.96], p < 0.0001) and 1-year mortality (26.5 to 22.1%, RR: 0.98 [0.97–0.98], p < 0.0001) decreased during the study period. Compared with controls, no significant change was seen in 30-day (aHR: 33.08 [95% CI: 25.12–43.55] to 24.64 [95% CI: 18.81–32.27], p = 0.0015 for interaction with calendar year) or 1-year (aHR: 5.85 [95% CI: 5.31–6.45] to 7.07 [95% CI: 6.43–7.78], p = 0.038) excess mortality. The 30-day excess mortality decreased significantly (aHR: 39.93 [95% CI: 28.47–56.00) to 24.63 [95% CI: 17.94–33.83], p = 0.0009) in patients with PE without known cancer before baseline, while the excess 1-year mortality increased (aHR: 3.55 [95% CI: 3.16–3.99] to 5.38 [95% CI: 4.85–5.98], p < 0.0001) in PE cases surviving to fill a prescription of anticoagulation. In DVT cases, 30-day and 1-year mortality declined, while excess mortality compared with controls remained stable.

Conclusion

In general, the improved mortality following PE and DVT paralleled population trends. However, PE cases without cancer had decreasing excess 30-day mortality, whereas those surviving to fill a prescription for anticoagulant medication showed increasing excess 1-year mortality.

Keywords

deep vein thrombosis - pulmonary embolism - mortality - trends

Data Availability Statement

The data that support the findings of this study are available from The National Board of Health and Welfare and Statistics, Sweden, but restrictions apply to the availability of these data, so they are not publicly available.


Authors' Contribution

K.G.S. planned the study. All authors, particularly M.T. and K.G.S., made important contributions to the design of this study. A.P. preformed statistical analyses. All authors were involved in interpreting the data. K.G.S. wrote the first draft of the manuscript. K.G.S., M.T., J.P., S.S., K.S., and C.J.S. provided clinical input at all stages of the project. All authors, particularly M.T. and K.G.S., reviewed and edited the manuscript. All authors approved the final draft.


Supplementary Material



Publikationsverlauf

Eingereicht: 20. Juni 2024

Angenommen: 20. August 2024

Accepted Manuscript online:
23. August 2024

Artikel online veröffentlicht:
12. September 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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Kommentar zu diesem Artikel:

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