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. 2015 Nov 1;116(9):1436-42.
doi: 10.1016/j.amjcard.2015.07.068. Epub 2015 Aug 14.

National Trends in Pulmonary Embolism Hospitalization Rates and Outcomes for Adults Aged ≥65 Years in the United States (1999 to 2010)

Karl E Minges  1 , Behnood Bikdeli  2 , Yun Wang  3 , Nancy Kim  4 , Jeptha P Curtis  5 , Mayur M Desai  6 , Harlan M Krumholz  7
Affiliations

National Trends in Pulmonary Embolism Hospitalization Rates and Outcomes for Adults Aged ≥65 Years in the United States (1999 to 2010)

Karl E Minges et al. Am J Cardiol. .

Abstract

Little is known about national trends of pulmonary embolism (PE) hospitalizations and outcomes in older adults in the context of recent diagnostic and therapeutic advances. Therefore, we conducted a retrospective cohort study of 100% Medicare fee-for-service beneficiaries hospitalized from 1999 to 2010 with a principal discharge diagnosis code for PE. The adjusted PE hospitalization rate increased from 129/100,000 person-years in 1999 to 302/100,000 person-years in 2010, a relative increase of 134% (p <0.001). Black patients had the highest rate of increase (174 to 548/100,000 person-years) among all age, gender, and race categories. The mean (standard deviation) length of hospital stay decreased from 7.6 (5.7) days in 1999 to 5.8 (4.4) days in 2010, and the proportion of patients discharged to home decreased from 51.1% (95% confidence interval [CI] 50.5 to 51.6) to 44.1% (95% CI 43.7 to 44.6), whereas more patients were discharged with home health care and to skilled nursing facilities. The in-hospital mortality rate decreased from 8.3% (95% CI 8.0 to 8.6) in 1999 to 4.4% (95% CI 4.2 to 4.5) in 2010, as did adjusted 30-day (from 12.3% [95% CI 11.9 to 12.6] to 9.1% [95% CI 8.5 to 9.7]) and 6-month mortality rates (from 23.0% [95% CI 22.5 to 23.4] to 19.6% [95% CI 18.8 to 20.5]). There were no significant racial differences in mortality rates by 2010. There was no change in the adjusted 30-day all-cause readmission rate from 1999 to 2010. In conclusion, PE hospitalization rates increased substantially from 1999 to 2010, with a higher rate for black patients. All mortality rates decreased but remained high. The increase in hospitalization rates and continued high mortality and readmission rates confirm the significant burden of PE for older adults.

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Conflict of interest statement

Conflict of Interest: Dr. Krumholz is the recipient of a research grant from Medtronic through Yale University. Dr. Krumholz chairs a cardiac scientific advisory board for UnitedHealth. Drs. Krumholz, Wang, and Curtis report that they receive contract funding from CMS to develop and maintain quality measures. Dr. Curtis receives salary support under contract with the National Cardiovascular Data Registry to provide analytic services in addition to equity interest in Medtronic. No other disclosures were reported.

Figures

Figure 1
Figure 1
Rates of Adjusted Hospitalization for Pulmonary Embolism by Overall and Race Subgroup, 1999 to 2010.
Figure 2
Figure 2
Rates of Mortality and Readmission for Pulmonary Embolism, 1999 to 2010.
See this image and copyright information in PMC

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