MedicalResearch.com Interview with:
Karl Minges, MPH PhD Candidate
Yale Graduate School of Arts & Sciences
Yale School of Nursing
Research Associate | Yale-New Haven Hospital Center for Outcomes Research & Evaluation (CORE)
McDougal Graduate Career Fellow | Yale Office of Career Strategy
Medical Research: What is the background for this study? What are the main findings?
Response: Pulmonary embolism, caused by a sudden blockage in the lung artery, is thought to be among the most treatable and preventable causes of death. This has been precipitated by several recent diagnostic and therapeutic advancements that have broadened the range of options for diagnosis, treatment, and management for pulmonary embolism in the past decade. In fact, the public health burden of pulmonary embolism is so great that the U.S. Surgeon General issued a Call to Action to prevent venous thromboembolism, comprising deep vein thrombosis and pulmonary embolism in 2008.
Despite recent diagnostic and therapeutic advances in pulmonary embolism treatment and prevention, little is known regarding the national trends of pulmonary embolism among older adults – a population that is adversely at risk. In this study, we identified the recent trends in pulmonary embolism hospitalizations and outcomes, such as in-hospital, 30-day and 6-month mortality using a 100% sample of Medicare beneficiaries from 1999 to 2010. We examined instances where pulmonary embolism was the primary or most serious reason for which the patient was in the hospital. Trends by age, sex, and race cohorts were also examined.
Medical Research: What should clinicians and patients take away from your report?
Response: Our analysis showed a substantial increase in the hospitalization rate for pulmonary embolism from 1999 to 2010. Adjusting for other factors that might be related to pulmonary embolism, we found that rates of hospitalization for pulmonary embolism more than doubled over the study period, from 129 per 100,000 person-years in 1999 to 302 per 100,000 person-years in 2010. Examining subgroups, Black patients and the oldest old (85 or older) were disproportionately hospitalized and had the greatest relative increase in hospitalizations over the study period. In 1999, Black patients had approximately 15% higher rate of hospitalizations for pulmonary embolism compared with White patients, and the difference more than doubled to 30% by 2010.
While hospitalizations have increased over time, our findings indicate that both short- and long-term mortality outcomes for pulmonary embolism have actually declined. In terms of the sex and race trends for adjusted 30-day and 6-month mortality, the disparity between men and women and White and Black patients diminished across the study period, and in the most recent years nearly all rates were equal.
Although Medicare data do not allow for the identification of the causes of these trends, several factors may explain the marked increase in hospitalizations and declines in mortality during our study period. One rationale may be the use of computed tomographic pulmonary angiography, a diagnostic technology that was introduced at the start of our study period, and has evolved into the standard of care for confirming a diagnosis of pulmonary embolism. However, the high sensitivity of this diagnostic technology may also result in the detection of small emboli that if left untreated would not cause symptoms or death. Yet, while we observed a high hospitalization rate of pulmonary embolism, we noted a strong signal in the direction of reduced in-hospital and longer-term mortality rates. This suggests that improved survival among Medicare beneficiaries may be at least partly attributable to the successful detection and treatment of clinically important emboli in recent years. Importantly, other factors may have a role in declining mortality rates, such as prevention efforts, more widespread prophylaxis and access to advanced therapies. Nevertheless, our results are likely explained by a combination of these factors.
In conclusion, pulmonary embolism hospitalization rates increased 138% from 1999 to 2010, with a higher rate for Black patients. All mortality rates declined but remained high. The rise in hospitalization rates and continued high mortality confirm the significant burden of pulmonary embolism for older adults.
Karl Minges, MPH PhD Candidate (2015). Pulmonary Embolism: Hospitalizations Rise, Mortality Decreases