Thromb Haemost 2021; 121(09): 1237-1245
DOI: 10.1055/s-0041-1725932
Stroke, Systemic or Venous Thromboembolism

Trends in Acute Pulmonary Embolism Admission Rates and Mortality Outcomes in Australia, 2002–2003 to 2017–2018: A Retrospective Cohort Study

Scott Hoskin
1  Department of Cardiology, Concord Hospital, The University of Sydney, Concord, NSW, Australia
,
David Brieger
1  Department of Cardiology, Concord Hospital, The University of Sydney, Concord, NSW, Australia
,
Vincent Chow
1  Department of Cardiology, Concord Hospital, The University of Sydney, Concord, NSW, Australia
,
Leonard Kritharides
1  Department of Cardiology, Concord Hospital, The University of Sydney, Concord, NSW, Australia
,
Austin Chin Chwan Ng
1  Department of Cardiology, Concord Hospital, The University of Sydney, Concord, NSW, Australia
› Author Affiliations
Funding None.

Abstract

Background Contemporary Australian epidemiological data on acute pulmonary embolism (PE) are lacking.

Objectives To determine the admission rates of acute PE in Australia, and to assess the temporal trends in short- and medium-term mortality following acute PE.

Methods Retrospective population-linkage study of all New South Wales residents admitted with a primary diagnosis of PE between January 1, 2002 and December 31, 2018 using data from the Centre for Health Record Linkage databases. Main outcome measures included temporal trends in total PE admissions and all-cause mortality at prespecified time points up to 1 year, stratified by gender.

Results There were 61,607 total PE admissions between 2002 and 2018 (mean ± standard deviation: 3,624 ± 429 admissions per annum; 50.42 ± 3.70 admissions per 100,000 persons per annum). The mean admission rate per annum was higher for females than for males (54.85 ± 3.65 vs. 44.91 ± 4.34 admissions per 100,000 persons per annum, respectively) and remained relatively stable for both genders throughout the study period. The main study cohort, limited to index PE admission only, comprised 46,382 persons (mean age: 64.6 ± 17.3 years; 44.4% males). The cumulative in-hospital, 30-day, 3-month, and 1-year mortality rates were 3.7, 5.6, 9.6, and 16.8%, respectively. When compared with 2002 as the reference year, there was a significant reduction in in-hospital (odds ratio [OR] = 0.34; 95% confidence interval [CI] = 0.25–0.46), 30-day (OR = 0.58, 95% CI = 0.46–0.73), and 1-year (hazard ratio = 0.74, 95% CI = 0.66–0.84) (all p < 0.001) mortality risk by 2017 after adjusting for age, gender, and relevant confounders. The survival improvements were seen in both genders and were greater for females than for males.

Conclusion Mortality following PE has improved with reductions observed in both short- and medium-term follow-ups between 2002 and 2018 with greater reductions in females despite their higher admission rates over time.

Note

No sponsors had a role in study design, data collection, data analysis, data interpretation, or writing of the report. All authors had full access to all the data in the study, and the corresponding author had final responsibility for the decision to submit for publication.


Ethical Considerations

The NSW Population and Health Services Research Ethics Committee granted a waiver of the usual requirement for the consent of the individuals to the use of their health information (reference number: 2013/09/479). All patient data were de-identified and analyzed anonymously.


Supplementary Material



Publication History

Received: 02 November 2020

Accepted: 23 December 2020

Publication Date:
28 February 2021 (online)

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