title: A comparison of patients diagnosed with pulmonary embolism who are ≥65 years with patients <65 years.
abstract: Recent studies have highlighted differences in how older patients respond to high-risk pulmonary embolism (PE) and treatment. However, guidelines for PE risk stratification and treatment are not based on age, and data are lacking for older patients. We characterized the impact of age on clinical features, risk stratification, treatment, and outcomes in a sample of patients with PE in the emergency department. We performed an observational cohort study of 547 consecutive patients with PE in the emergency department from 2005 to 2011 in an urban tertiary hospital. We used bivariate proportions and multivariable logistic regression to compare clinical presentation, risk category, treatment, and outcomes in patients ≥65 years with those <65 years. The mean age was 58 ± 17 years, 276 (50%) were women, and 210 (38%) were ≥65 years. PE was more severe in patients ≥65 years (massive 14% vs 5%, submassive 48% vs 25%, and low risk 38% vs 70%, p <0.0001), with submassive PE being the most common presentation in patients ≥65 years. However, subanalysis removing natriuretic peptides from the definition of submassive PE negated this finding. Treatment with parenteral anticoagulation (88% vs 90%, p = 0.32), thrombolytic therapy (5% vs 4%, p = 0.87), and inferior vena cava filter (4% vs 4%, p = 0.73) were similar among age groups. Patients ≥65 years had higher 30-day mortality (11% vs 3%, p <0.001). In conclusion, patients ≥65 years present with more severe PE and have higher mortality, although treatment patterns were similar to younger patients. Age-specific guideline definitions of submassive PE may better identify high-risk patients.
authors.affiliation: Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston, Massachusetts; Center for Vascular Emergencies, Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Philip
authors.initials: P
authors.lastname: Cefalo
authors.affiliation: Division of Cardiology and Vascular Medicine, Department of Medicine, The Institute for Heart, Vascular and Stroke Care, Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Ido
authors.initials: I
authors.lastname: Weinberg
authors.affiliation: Cardiovascular Diseases Section, Department of Internal Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma.
authors.forename: Beau M
authors.initials: BM
authors.lastname: Hawkins
authors.affiliation: Center for Vascular Emergencies, Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Praveen
authors.initials: P
authors.lastname: Hariharan
authors.affiliation: Center for Vascular Emergencies, Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Ikenna
authors.initials: I
authors.lastname: Okechukwu
authors.affiliation: Center for Vascular Emergencies, Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Blair A
authors.initials: BA
authors.lastname: Parry
authors.affiliation: Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Yuchiao
authors.initials: Y
authors.lastname: Chang
authors.affiliation: Center for Vascular Emergencies, Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts; Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Rachel
authors.initials: R
authors.lastname: Rosovsky
authors.affiliation: Center for Vascular Emergencies, Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Shan W
authors.initials: SW
authors.lastname: Liu
authors.affiliation: Division of Cardiology and Vascular Medicine, Department of Medicine, The Institute for Heart, Vascular and Stroke Care, Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Michael R
authors.initials: MR
authors.lastname: Jaff
authors.affiliation: Center for Vascular Emergencies, Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts; The Institute for Heart, Vascular, and Stroke Care, Massachusetts General Hospital, Boston, Massachusetts. Electronic address: ckabrhel@partners.org.
authors.forename: Christopher
authors.initials: C
authors.lastname: Kabrhel
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000627:therapeutic use; D015331:Cohort Studies; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011655:Pulmonary Embolism / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy*; D018570:Risk Assessment; D015912:Thrombolytic Therapy; D016306:Vena Cava Filters
chemical_list: D000925:Anticoagulants