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Trends in Acute Pulmonary Embolism Admission Rates and Mortality Outcomes in Australia, 2002–2003 to 2017–2018: A Retrospective Cohort StudyFunding None.
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.
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.
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.
Received: 02 November 2020
Accepted: 23 December 2020
28 February 2021 (online)
© 2021. Thieme. All rights reserved.
Georg Thieme Verlag KG
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- 1 Gouveia M, Pinheiro L, Costa J, Borges M. Pulmonary embolism in Portugal: epidemiology and in-hospital mortality [in Portuguese]. Acta Med Port 2016; 29 (7–8): 432-440
- 2 Cohen AT, Agnelli G, Anderson FA. et al; VTE Impact Assessment Group in Europe (VITAE). Venous thromboembolism (VTE) in Europe. The number of VTE events and associated morbidity and mortality. Thromb Haemost 2007; 98 (04) 756-764
- 3 Shiraev TP, Omari A, Rushworth RL. Trends in pulmonary embolism morbidity and mortality in Australia. Thromb Res 2013; 132 (01) 19-25
- 4 Goldhaber SZ, Visani L, De Rosa M. Acute pulmonary embolism: clinical outcomes in the International Cooperative Pulmonary Embolism Registry (ICOPER). Lancet 1999; 353 (9162): 1386-1389
- 5 Ng AC, Chung T, Yong AS. et al. Long-term cardiovascular and noncardiovascular mortality of 1023 patients with confirmed acute pulmonary embolism. Circ Cardiovasc Qual Outcomes 2011; 4 (01) 122-128
- 6 Bikdeli B, Wang Y, Jimenez D. et al. Pulmonary embolism hospitalization, readmission, and mortality rates in US older adults, 1999-2015. JAMA 2019; 322 (06) 574-576
- 7 Centre for Health Record Linkage (CHeReL). Accessed January 20, 2021 at: http://www.cherel.org.au
- 8 Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 1987; 40 (05) 373-383
- 9 Australian Bureau of Statistics. Accessed March, 2020 at: http://www.abs.gov.au
- 10 Aylin P, Bottle A, Kirkwood G, Bell D. Trends in hospital admissions for pulmonary embolism in England: 1996/7 to 2005/6. Clin Med (Lond) 2008; 8 (04) 388-392
- 11 Smith SB, Geske JB, Kathuria P. et al. Analysis of national trends in admissions for pulmonary embolism. Chest 2016; 150 (01) 35-45
- 12 de Miguel-Díez J, Jiménez-García R, Jiménez D. et al. Trends in hospital admissions for pulmonary embolism in Spain from 2002 to 2011. Eur Respir J 2014; 44 (04) 942-950
- 13 Shah P, Arora S, Kumar V. et al. Short-term outcomes of pulmonary embolism: a national perspective. Clin Cardiol 2018; 41 (09) 1214-1224
- 14 Jiménez D, de Miguel-Díez J, Guijarro R. et al; RIETE Investigators. Trends in the management and outcomes of acute pulmonary embolism: analysis from the RIETE registry. J Am Coll Cardiol 2016; 67 (02) 162-170
- 15 Agarwal S, Clark III D, Sud K, Jaber WA, Cho L, Menon V. Gender disparities in outcomes and resource utilization for acute pulmonary embolism hospitalizations in the United States. Am J Cardiol 2015; 116 (08) 1270-1276
- 16 Spencer FA, Gore JM, Lessard D, Douketis JD, Emery C, Goldberg RJ. Patient outcomes after deep vein thrombosis and pulmonary embolism: the Worcester Venous Thromboembolism Study. Arch Intern Med 2008; 168 (04) 425-430
- 17 Keller K, Rappold L, Gerhold-Ay A. et al. Sex-specific differences in pulmonary embolism. Thromb Res 2019; 178: 173-181
- 18 McHugh KB, Visani L, DeRosa M, Covezzoli A, Rossi E, Goldhaber SZ. Gender comparisons in pulmonary embolism (results from the International Cooperative Pulmonary Embolism Registry [ICOPER]). Am J Cardiol 2002; 89 (05) 616-619
- 19 Park B, Messina L, Dargon P, Huang W, Ciocca R, Anderson FA. Recent trends in clinical outcomes and resource utilization for pulmonary embolism in the United States: findings from the nationwide inpatient sample. Chest 2009; 136 (04) 983-990
- 20 Olié V, Fuhrman C, Chin F, Lamarche-Vadel A, Scarabin PY, de Peretti C. Time trends in pulmonary embolism mortality in France, 2000-2010. Thromb Res 2015; 135 (02) 334-338
- 21 Hepburn-Brown M, Darvall J, Hammerschlag G. Acute pulmonary embolism: a concise review of diagnosis and management. Intern Med J 2019; 49 (01) 15-27
- 22 Wiener RS, Schwartz LM, Woloshin S. Time trends in pulmonary embolism in the United States: evidence of overdiagnosis. Arch Intern Med 2011; 171 (09) 831-837
- 23 Quan H, Li B, Couris CM. et al. Updating and validating the Charlson comorbidity index and score for risk adjustment in hospital discharge abstracts using data from 6 countries. Am J Epidemiol 2011; 173 (06) 676-682
- 24 Ng AC, Chow V, Yong AS, Chung T, Kritharides L. Prognostic impact of the Charlson comorbidity index on mortality following acute pulmonary embolism. Respiration 2013; 85 (05) 408-416
- 25 Ng AC, Adikari D, Yuan D. et al. The prevalence and incidence of atrial fibrillation in patients with acute pulmonary embolism. PLoS One 2016; 11 (03) e0150448
- 26 Ptaszynska-Kopczynska K, Kiluk I, Sobkowicz B. Atrial fibrillation in patients with acute pulmonary embolism: clinical significance and impact on prognosis. BioMed Res Int 2019; 2019: 7846291
- 27 Barra SN, Paiva LV, Providência R, Fernandes A, Leitão Marques A. Atrial fibrillation in acute pulmonary embolism: prognostic considerations. Emerg Med J 2014; 31 (04) 308-312
- 28 Aujesky D, Jiménez D, Mor MK, Geng M, Fine MJ, Ibrahim SA. Weekend versus weekday admission and mortality after acute pulmonary embolism. Circulation 2009; 119 (07) 962-968
- 29 Nanchal R, Kumar G, Taneja A. et al; from the Milwaukee Initiative in Critical Care Outcomes Research (MICCOR) Group of Investigators. Pulmonary embolism: the weekend effect. Chest 2012; 142 (03) 690-696
- 30 Gallerani M, Imberti D, Ageno W, Dentali F, Manfredini R. Higher mortality rate in patients hospitalised for acute pulmonary embolism during weekends. Thromb Haemost 2011; 106 (01) 83-89
- 31 Access Economics Pty Limited. The burden of venous thromboembolism in Australia. 2008 . Accessed January 20, 2021 at: https://www.safetyandquality.gov.au/publications-and-resources/resource-library/burden-venous-thromboembolism-australia
- 32 Lam MK. How good is New South Wales admitted patient data collection in recording births?. Health Inf Manag 2011; 40 (03) 12-19
- 33 Marsden DL, Spratt NJ, Walker R. et al. Trends in stroke attack rates and case fatality in the Hunter region, Australia 1996-2008. Cerebrovasc Dis 2010; 30 (05) 500-507