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Improvements in initial treatment and a shortened length of hospital stay reduced the short-term all-cause and pulmonary embolism-specific mortality, according to research published in the Journal of the American College of Cardiology.
Pulmonary embolism (PE) is the most common cause of vascular death and preventable death for in hospital patients. Researchers developed the RIETE (Registro Informatizado de la Enfermedad Tromboembólica) registry to track temporal changes in PE management and outcome. Since the registry’s launch in 2001, investigators have enrolled 50 782 patients, 25 456 of whom have PE.
“The RIETE registry is the only large-scale, multinational, observational study of the spectrum of patients diagnosed with a PE with continuous recruitment of patients for more than 10 years, and it offers a unique opportunity to look at a number of patients in various treatment settings over a long period of time,” the authors wrote.
This analysis included 23 858 adults with acute PE who were enrolled in the registry between 2001 and 2013. Researchers used the data from the registry to examine trends in length of hospital stay and the use of pharmacological and interventional strategies. They also calculated all-cause and PE-related mortality rates within 30 days to examine temporal trends of hospital care.
The average length of hospital stay decreased from 13.6 to 9.3 days during the study (32% relative reduction, P<.001).
Among the PE initial treatments, the researchers found that the use of low-molecular-weight heparin increased from 77% to 84%, and the use of unfractionated heparin decreased from 22% to 8.4% (P<.01 for all comparisons). Thrombolytic therapy use increased from 0.7% to 1.0% (P=.07) and surgical embolectomy increased from 0.3% to 0.6% (P<.01).
All-cause mortality rates decreased from 6.6% in the first period of the study (2001 to 2005) to 4.9% in the last period (2010 to 2013) (P=.02). PE-related mortality rates also decreased from 3.3% in the first period to 1.8% in the last period (P<.01).
“The risk status of patients at presentation with PE did not improve over the course of the present study, so it may be plausible that the changes in clinical outcomes were a consequence of changes in practice,” the authors noted.
Reference
Jiménez D, de Miguel-Diéz J, Guijarro R, et al; for the RIETE Investigators. Trends in the Management and Outcomes of Acute Pulmonary Embolism. J Am Coll Cardiol. 2016; 67(2):162-170. DOI: 10.1016/j.jacc.2015.10.060.
