title: Trends in the Management and Outcomes of Acute Pulmonary Embolism: Analysis From the RIETE Registry.
abstract: BACKGROUND
  Despite advances in hospital management in recent years, it is not clear whether mortality after acute pulmonary embolism (PE) has decreased over time.
  
  
  OBJECTIVE
  This study describes the trends in the management and outcomes of acute symptomatic PE.
  
  
  METHODS
  We identified adults with acute PE enrolled in the registry between 2001 and 2013. We assessed temporal trends in length of hospital stay and use of pharmacological and interventional therapies. Using multivariable regression, we examined temporal trends in risk-adjusted rates of all-cause and PE-related death to 30 days after diagnosis.
  
  
  RESULTS
  Among 23,858 patients with PE, mean length of stay decreased from 13.6 to 9.3 days over time (32% relative reduction, p < 0.001). For initial treatment, use of low-molecular-weight heparin increased from 77% to 84%, whereas the use of unfractionated heparin decreased from 22% to 8.4% (p < 0.001 for trend for all comparisons). Thrombolytic therapy use increased from 0.7% to 1.0% (p = 0.07 for trend) and surgical embolectomy use doubled from 0.3% to 0.6% (p < 0.01 for trend). Risk-adjusted rates of all-cause mortality decreased from 6.6% in the first period (2001 to 2005) to 4.9% in the last period (2010 to 2013) (p = 0.02 for trend). Rates of PE-related mortality decreased over time, with a risk-adjusted rate of 3.3% in 2001 to 2005 and 1.8% in 2010 to 2013 (p < 0.01 for trend).
  
  
  CONCLUSIONS
  In a large international registry of patients with PE, improvements in length of stay and changes in the initial treatment were accompanied by a reduction in short-term all-cause and PE-specific mortality.
authors.affiliation: Respiratory Department, Ramón y Cajal Hospital and Instituto Ramón y Cajal de Investigación Sanitaria IRYCIS, Madrid, Spain. Electronic address: djimenez.hrc@gmail.com.
authors.forename: David
authors.initials: D
authors.lastname: Jiménez
authors.affiliation: Respiratory Department, Hospital Universitario Gregorio Marañón, Madrid, Spain.
authors.forename: Javier
authors.initials: J
authors.lastname: de Miguel-Díez
authors.affiliation: Internal Medicine Department, Biomedical Institute of Malaga (IBIMA), Hospital Regional Universitario de Malaga, Malaga, Spain.
authors.forename: Ricardo
authors.initials: R
authors.lastname: Guijarro
authors.affiliation: Medicine Department, Santa Lucía Hospital, Cartagena, Murcia, Spain.
authors.forename: Javier
authors.initials: J
authors.lastname: Trujillo-Santos
authors.affiliation: Respiratory Department, Virgen del Rocío Hospital and Instituto de Biomedicina, Sevilla, and CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain.
authors.forename: Remedios
authors.initials: R
authors.lastname: Otero
authors.affiliation: Medicine Department, Hospital Rey Juan Carlos, Móstoles, Spain.
authors.forename: Raquel
authors.initials: R
authors.lastname: Barba
authors.affiliation: Biostatistics Department, Ramón y Cajal Hospital and Instituto Ramón y Cajal de Investigación Sanitaria IRYCIS, CIBERESP, Madrid, Spain.
authors.forename: Alfonso
authors.initials: A
authors.lastname: Muriel
authors.affiliation: Université Paris Descartes, Sorbonne Paris Cité, and Division of Respiratory and Intensive Care Medicine, Hôpital Européen Georges Pompidou, AP-HP, Paris, France.
authors.forename: Guy
authors.initials: G
authors.lastname: Meyer
authors.affiliation: Divisions of Pulmonary and Critical Care Medicine and General Medical Sciences, Washington University School of Medicine, St. Louis, Missouri.
authors.forename: Roger D
authors.initials: RD
authors.lastname: Yusen
authors.affiliation: Department of Internal Medicine, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, and Universidad Católica de Murcia, Murcia, Spain.
authors.forename: Manuel
authors.initials: M
authors.lastname: Monreal
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D019468:Disease Management; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006495:Heparin, Low-Molecular-Weight / Q000627:therapeutic use*; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D011379:Prognosis; D011655:Pulmonary Embolism / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D018570:Risk Assessment; D013030:Spain / Q000453:epidemiology; D016019:Survival Analysis; D017131:Thrombectomy / Q000379:methods / Q000706:statistics & numerical data; D015912:Thrombolytic Therapy / Q000379:methods / Q000706:statistics & numerical data
chemical_list: D005343:Fibrinolytic Agents; D006495:Heparin, Low-Molecular-Weight
keywords: heparin; length of stay; outcomes; prognosis; surgical embolectomy; survival; thrombolysis