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Temporal trends in management and outcome of pulmonary embolism: a single-centre experience

Background Real-world data on the impact of advances in risk-adjusted management on the outcome of patients with pulmonary embolism (PE) are limited. Methods To investigate temporal trends in treatment, in-hospital adverse outcomes and 1-year mortality, we analysed data from 605 patients [median age...

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Published in:Clinical research in cardiology 2020-01, Vol.109 (1), p.67-77
Main Authors: Ebner, Matthias, Kresoja, Karl-Patrik, Keller, Karsten, Hobohm, Lukas, Rogge, Nina I. J., Hasenfuß, Gerd, Pieske, Burkert, Konstantinides, Stavros V., Lankeit, Mareike
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container_title Clinical research in cardiology
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creator Ebner, Matthias
Kresoja, Karl-Patrik
Keller, Karsten
Hobohm, Lukas
Rogge, Nina I. J.
Hasenfuß, Gerd
Pieske, Burkert
Konstantinides, Stavros V.
Lankeit, Mareike
description Background Real-world data on the impact of advances in risk-adjusted management on the outcome of patients with pulmonary embolism (PE) are limited. Methods To investigate temporal trends in treatment, in-hospital adverse outcomes and 1-year mortality, we analysed data from 605 patients [median age, 70 years (IQR 56–77) years, 53% female] consecutively enrolled in a single-centre registry between 09/2008 and 08/2016. Results Over the 8-year period, more patients were classified to lower risk classes according to the European Society of Cardiology (ESC) 2014 guideline algorithm while the number of high-risk patients with out-of-hospital cardiac arrest (OHCA) increased. Although patients with OHCA had an exceptionally high in-hospital mortality rate of 59.3%, the rate of PE-related in-hospital adverse outcomes (12.2%) in the overall patient cohort remained stable over time. The rate of reperfusion treatment was 9.6% and tended to increase in high-risk patients. We observed a decrease in the median duration of in-hospital stay from 10 (IQR 6–14) to 7 (IQR 4–15) days, an increase of patients discharged early from 2.1 to 12.2% and an increase in the use of non-vitamin K-dependent oral anticoagulants (NOACs) from 12.6 to 57.2% in the last 2 years (09/2014–08/2016) compared to first 6 years (09/2008–08/2014). The 1-year mortality rate (16.9%) remained stable throughout the study period. Conclusion In-hospital adverse outcomes and 1-year mortality remained stable despite more patients with OHCA, shorter in-hospital stays, more patients discharged early and a more frequent NOAC use.
doi_str_mv 10.1007/s00392-019-01489-9
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J. ; Hasenfuß, Gerd ; Pieske, Burkert ; Konstantinides, Stavros V. ; Lankeit, Mareike</creator><creatorcontrib>Ebner, Matthias ; Kresoja, Karl-Patrik ; Keller, Karsten ; Hobohm, Lukas ; Rogge, Nina I. J. ; Hasenfuß, Gerd ; Pieske, Burkert ; Konstantinides, Stavros V. ; Lankeit, Mareike</creatorcontrib><description>Background Real-world data on the impact of advances in risk-adjusted management on the outcome of patients with pulmonary embolism (PE) are limited. Methods To investigate temporal trends in treatment, in-hospital adverse outcomes and 1-year mortality, we analysed data from 605 patients [median age, 70 years (IQR 56–77) years, 53% female] consecutively enrolled in a single-centre registry between 09/2008 and 08/2016. Results Over the 8-year period, more patients were classified to lower risk classes according to the European Society of Cardiology (ESC) 2014 guideline algorithm while the number of high-risk patients with out-of-hospital cardiac arrest (OHCA) increased. Although patients with OHCA had an exceptionally high in-hospital mortality rate of 59.3%, the rate of PE-related in-hospital adverse outcomes (12.2%) in the overall patient cohort remained stable over time. The rate of reperfusion treatment was 9.6% and tended to increase in high-risk patients. We observed a decrease in the median duration of in-hospital stay from 10 (IQR 6–14) to 7 (IQR 4–15) days, an increase of patients discharged early from 2.1 to 12.2% and an increase in the use of non-vitamin K-dependent oral anticoagulants (NOACs) from 12.6 to 57.2% in the last 2 years (09/2014–08/2016) compared to first 6 years (09/2008–08/2014). The 1-year mortality rate (16.9%) remained stable throughout the study period. Conclusion In-hospital adverse outcomes and 1-year mortality remained stable despite more patients with OHCA, shorter in-hospital stays, more patients discharged early and a more frequent NOAC use.</description><identifier>ISSN: 1861-0684</identifier><identifier>EISSN: 1861-0692</identifier><identifier>DOI: 10.1007/s00392-019-01489-9</identifier><identifier>PMID: 31065790</identifier><language>eng</language><publisher>Berlin/Heidelberg: Springer Berlin Heidelberg</publisher><subject>Algorithms ; Anticoagulants ; Cardiology ; Embolism ; Embolisms ; Medicine ; Medicine &amp; Public Health ; Mortality ; Original Paper ; Patients ; Pulmonary embolisms ; Reperfusion ; Risk ; Risk groups ; Risk management ; Trends ; Vitamin K</subject><ispartof>Clinical research in cardiology, 2020-01, Vol.109 (1), p.67-77</ispartof><rights>The Author(s) 2019</rights><rights>Clinical Research in Cardiology is a copyright of Springer, (2019). All Rights Reserved. This work is published under http://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c474t-17a253774ec122fc28c09233e3ab2fa7994497191aa062b22a0293553d0266583</citedby><cites>FETCH-LOGICAL-c474t-17a253774ec122fc28c09233e3ab2fa7994497191aa062b22a0293553d0266583</cites><orcidid>0000-0001-5211-7997</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,780,784,885,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31065790$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Ebner, Matthias</creatorcontrib><creatorcontrib>Kresoja, Karl-Patrik</creatorcontrib><creatorcontrib>Keller, Karsten</creatorcontrib><creatorcontrib>Hobohm, Lukas</creatorcontrib><creatorcontrib>Rogge, Nina I. 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Results Over the 8-year period, more patients were classified to lower risk classes according to the European Society of Cardiology (ESC) 2014 guideline algorithm while the number of high-risk patients with out-of-hospital cardiac arrest (OHCA) increased. Although patients with OHCA had an exceptionally high in-hospital mortality rate of 59.3%, the rate of PE-related in-hospital adverse outcomes (12.2%) in the overall patient cohort remained stable over time. The rate of reperfusion treatment was 9.6% and tended to increase in high-risk patients. We observed a decrease in the median duration of in-hospital stay from 10 (IQR 6–14) to 7 (IQR 4–15) days, an increase of patients discharged early from 2.1 to 12.2% and an increase in the use of non-vitamin K-dependent oral anticoagulants (NOACs) from 12.6 to 57.2% in the last 2 years (09/2014–08/2016) compared to first 6 years (09/2008–08/2014). The 1-year mortality rate (16.9%) remained stable throughout the study period. 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Methods To investigate temporal trends in treatment, in-hospital adverse outcomes and 1-year mortality, we analysed data from 605 patients [median age, 70 years (IQR 56–77) years, 53% female] consecutively enrolled in a single-centre registry between 09/2008 and 08/2016. Results Over the 8-year period, more patients were classified to lower risk classes according to the European Society of Cardiology (ESC) 2014 guideline algorithm while the number of high-risk patients with out-of-hospital cardiac arrest (OHCA) increased. Although patients with OHCA had an exceptionally high in-hospital mortality rate of 59.3%, the rate of PE-related in-hospital adverse outcomes (12.2%) in the overall patient cohort remained stable over time. The rate of reperfusion treatment was 9.6% and tended to increase in high-risk patients. We observed a decrease in the median duration of in-hospital stay from 10 (IQR 6–14) to 7 (IQR 4–15) days, an increase of patients discharged early from 2.1 to 12.2% and an increase in the use of non-vitamin K-dependent oral anticoagulants (NOACs) from 12.6 to 57.2% in the last 2 years (09/2014–08/2016) compared to first 6 years (09/2008–08/2014). The 1-year mortality rate (16.9%) remained stable throughout the study period. Conclusion In-hospital adverse outcomes and 1-year mortality remained stable despite more patients with OHCA, shorter in-hospital stays, more patients discharged early and a more frequent NOAC use.</abstract><cop>Berlin/Heidelberg</cop><pub>Springer Berlin Heidelberg</pub><pmid>31065790</pmid><doi>10.1007/s00392-019-01489-9</doi><tpages>11</tpages><orcidid>https://orcid.org/0000-0001-5211-7997</orcidid><oa>free_for_read</oa></addata></record>
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subjects Algorithms
Anticoagulants
Cardiology
Embolism
Embolisms
Medicine
Medicine & Public Health
Mortality
Original Paper
Patients
Pulmonary embolisms
Reperfusion
Risk
Risk groups
Risk management
Trends
Vitamin K
title Temporal trends in management and outcome of pulmonary embolism: a single-centre experience
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