title: Long-term cardiovascular and noncardiovascular mortality of 1023 patients with confirmed acute pulmonary embolism.
abstract: BACKGROUND
  There are currently no guidelines advising long-term surveillance of patients following an acute pulmonary embolism (PE), because long-term outcome studies are rare. We investigated the long-term cardiovascular and all-cause mortality of a large patient cohort with confirmed PE in relation to baseline cardiovascular disease (CVD).
  
  
  RESULTS
  Clinical details of all patients presenting with acute PE to a tertiary hospital were retrieved from medical records, and their survival tracked from a statewide death registry. There were 1023 (45% males) patients admitted with confirmed PE from 2000 to 2007. During a mean follow-up of 3.8±2.6 years, 363 patients died (35.5%), of whom only 31 (3.0%) died in-hospital during the index PE admission. The 3-month, 6-month, 1-year, 3-year, and 5-year cumulative mortality rates were 8.3%, 11.1%, 16.3%, 26.7%, and 31.6% respectively. Annual mortality did not improve over the 7-year period. The postdischarge mortality of 8.5%/patient-year was 2.5-fold that of an age- and sex-matched general population, being 12.6-fold in the youngest quintile (<55 years) and 1.9-fold in the oldest quintile (≥83 years). Patients with known CVD at baseline had 2.2-fold greater all-cause mortality than those without CVD, and this effect, although at a lower level of risk, remained significant after multivariate analysis. Of the 332 deaths occurring postdischarge, 40% were attributed to cardiovascular causes.
  
  
  CONCLUSIONS
  In a contemporary adult population, PE is associated with a substantially increased long-term mortality, of which nearly half is cardiovascular. Our study highlights the urgent need to develop long-term surveillance strategies in this population.
authors.affiliation: Cardiology Department, Concord Hospital & The University of Sydney, Concord, Australia.
authors.forename: Austin Chin Chwan
authors.initials: AC
authors.lastname: Ng
authors.forename: Tommy
authors.initials: T
authors.lastname: Chung
authors.forename: Andy Sze Chiang
authors.initials: AS
authors.lastname: Yong
authors.forename: Helen Siu Ping
authors.initials: HS
authors.lastname: Wong
authors.forename: Vincent
authors.initials: V
authors.lastname: Chow
authors.forename: David Stephen
authors.initials: DS
authors.lastname: Celermajer
authors.forename: Leonard
authors.initials: L
authors.lastname: Kritharides
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002318:Cardiovascular Diseases / Q000401:mortality*; D002423:Cause of Death; D015897:Comorbidity; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000401:mortality; D011655:Pulmonary Embolism / Q000401:mortality*