Signs and symptoms of acute pulmonary embolism and their predictive value for all-cause hospital death in respect of severity of the disease, age, sex and body mass index: retrospective analysis of the Regional PE Registry (REPER) (original) (raw)
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Kardiologia polska, 2012
Despite significant progress on the diagnosis work-up of patients with suspented acute pulmonary embolism (APE), several therapeutic and prognostic issues have not yet been well established. We analysed the clinical course of 353 consecutive patients (141 males, 212 females, mean age 64.7 ± 18.12 years) with APE confirmed by contrast-enhanced multidetector computed tomography who were diagnosed and treated in a reference hospital between 2007 and 2009. Among patients with APE, groups with high (HR), intermediate (IR) and low (LR) risk of early mortality were defined according to the recent European Society of Cardiology guidelines. High, intermediate and low risk groups included 23 patients (10 M, 13 F, age 70.13 ± 16.95 years), 146 patients (61 M, 85 F, age 65.77 ± 17.74 years), and 184 patients (70 M, 114 F, age 63.17 ± 18.45 years), respectively. Majority of patients (91.8%) were anticoagulated only with unfractionated or low-molecular-weight heparin, and thrombolysis was used in...
The Distribution of the Main Risk Factors in Patients with Intermediate-High Risk Pulmonary Embolism
Romanian Medical Journal, 2021
The pulmonary embolism (PE) represents a medical condition with increasing incidence. The various clinical forms of PE have different prognosis, related to the presence of markers of right ventricle (RV) dysfunction (biochemical or imagistic). Material and method. In this study we included 82 consecutive patients with intermediate-high risk PE, assessing the main risk factors distribution. We divided the patients in two groups, study group - receiving thrombolytic therapy (ateplase (t-Pa)) associated to anticoagulation (unfractionated heparin (UFH)) – and control group – receiving anticoagulation alone -. The inclusion in study group was indicated by the high bleeding risk, in this group being included patients without contraindications for thrombolysis, patients without severe renal dysfunction and patients with body mass index (BMI) 18.5-29.9 kg/m2. We assessed the gender distribution in the two groups, the medium age distribution and the main PE risk factors in the two groups. Al...
Internal and Emergency Medicine, 2014
Pulmonary Embolism (PE) incidence increases with age. Data on mortality and prognosis in elderly patients with suspected PE are lacking. (1) To assess 30and 90-day mortality in subjects with PE from an elderly population seen in the emergency department (ED); (2) to test the prognostic accuracy of a simplified Pulmonary Embolism Severity Index (sPESI) coupled to a highly sensitive cardiac Troponin T (hs-cTnT) level. A retrospective cohort study was performed, including patients evaluated in the ED of Vimercate Hospital for clinically suspected PE from 2010 to 2012. Study population: n = 470, 63.4 % women, mean age ± SD 73.06 ± 16.0 years, 40 % aged C80 and 77.7 % C65 years old, confirmed PE: 22.6 % (106 cases). Within 30 and 90 days, mortality among patients with confirmed PE was 14.2 % (8.8-22.0) and 20.8 % (16.5-41.7). In subjects aged C80 years, 30-day mortality was 18.9 % among patients with confirmed PE, and 12.6 % among those with PE excluded (p = 0.317). Ninety-day mortality rates were 29.7 and 19.9 %, respectively (p = 0.193). In patients with confirmed PE, Negative Predictive Value of sPESI was 94.1 % (80.3-99.3) for 30 days and 88.2 % (72.3-96.7) for 90-day mortality. Adding the hs-cTnT level to sPESI did not improve its performance. (1) In an elderly population referring to the ED with clinically suspected PE, mortality was high both in subjects with and without confirmed PE; (2) the ability of sPESI and hs-cTnT to predict PE mortality seems to be lower than reported in studies based on data from younger populations. Better risk stratification tools will be necessary to improve clinical management in this setting.
Revista de Chimie
Pulmonary thromboembolism is currently one of the leading causes of disease burden and mortality in Europe, also known as the great masquerader, for its ability to mimic other diseases or to present itself with few symptoms, especially when the pulmonary embolism is very small. With aging population, increased survival of cancer patients and the addition of multiple debilitating diseases such as dementia, heart failure, chronic kidney disease the rate of pulmonary embolism is spiking, with more and more small pulmonary embolism being diagnosed, that may have no immediate impact on mortality, but which may contribute to an increase in morbidity. We have examined retrospectively 108 consecutively cases of pulmonary thromboembolism that have presented in the Emergency Department of Municipal Hospital in Timisoara, Romania over the course of twenty-one months from September 2016 to May 2018 and we evaluated the clinical and laboratory findings in studying the influence of age over the s...
Archives of Academic Emergency Medicine, 2019
Introduction: Pulmonary embolism (PE) is a potentially life threatening disease, accurate and timely diagnosis of which is still a challenge that physicians face. This study was designed with the aim of evaluating the relationship between thrombosis risk factors, clinical symptoms, and laboratory findings with the presence or absence of PE. Methods: The present retrospective cross-sectional study was performed on patients with suspected pulmonary embolism who were hospitalized in different departments of Shohadaye Tajrish Hospital, Tehran, Iran, during 1 year. All patients underwent computed tomography pulmonary angiography (CTPA) and then thrombosis risk factors, clinical symptoms, and laboratory findings of confirmed PE cases with CTPA were compared with others. Results: 188 patients with the mean age of 61.91 ± 18.25 (20 – 101) years were studied (54.8% male). Based on Wells' score, 32 (17.2%) patients were in the low risk group, 145 (78.0%) were in the moderate risk group, a...
Journal of Thrombosis and Haemostasis, 2013
ABSTRACT Pulmonary embolism (PE) is a common condition in the Emergency Department and its incidence increases exponentially with age [1]. PE remains largely underdiagnosed and inappropriately treated, resulting in suboptimal outcomes. This is partly due to the fact that clinical symptoms and signs are nonspecific [2]. © 2012 International Society on Thrombosis and Haemostasis.
Mortality from Pulmonary Embolism by Clinical Severity
The Physician
Aim: To report all-cause and PE related short term mortality by clinical severity of PE and to identify any missed opportunities for thrombolysis. Background: Mortality related to pulmonary embolism varies widely in the reported literature even for the same clinical severity category of PE. Method: Electronic medical records of all patients presenting to a large tertiary care teaching hospital in London, between October 1, 2018, and January 16, 2020, who had a discharge diagnosis of acute pulmonary embolism were reviewed retrospectively. Results: There was no PE related mortality in the low-risk PE group. There was one PE related death in the submassive PE group (1.47% mortality on day 14 and day 30). Massive PE was associated with a 29.4% PE related mortality short-term mortality.
Acute pulmonary embolism in elderly: clinical characteristics and outcome
International Journal of Cardiology, 2005
Objective: To evaluate the clinical characteristics and outcome of acute pulmonary embolism in elderly in comparison to the younger patients. Methods: Study population consisted of 136 patients with a confirmed diagnosis of acute pulmonary embolism. Clinical characteristics and thromboembolic risk factors were analyzed between the elderly ( z 65 years of age) and the younger ( < 65 years of age) patients. In-hospital mortality was used as a measure of outcome. Results: Elderly group consisted of 70 patients (age 76.4 F 8.3 years, range 65 -96 years; females 58%) and younger group of 66 patients (age 48.5 F 12 years, range 18 -64 years, females 59%). Syncope was more frequent in elderly group (19% vs. 6%, P = 0.03) but the symptoms of shortness of breath and pleuritic chest pain were not significantly different between groups. Malignancy was the most common risk factor for thrombo-embolism, but immobilization predominated among patients in elderly group (21% vs. 6%, P = 0.01). Tachycardia was common in younger patients compared to the elderly. Ventilationperfusion scan was used more commonly in younger patients (76% vs. 57%, P = 0.02), whereas, helical computed-tomography scan was used equally in both groups. Most of the patients had lower extremity duplex study (97% in each group). Inferior vena cava filter placement was common and thrombolytic therapy rare among elderly patients. Patients in elderly group had higher in-hospital mortality (17% vs. 5%, P = 0.02). Conclusions: Syncope is a more frequent presenting symptom and immobilization a common risk factor in elderly patients with acute pulmonary embolism. In addition, they have higher in-hospital mortality.
Pulmonary embolism in the elderly: a review on clinical, instrumental and laboratory presentation
Vascular health and risk management, 2008
Diagnosis of pulmonary embolism (PE) remains difficult and is often missed in the elderly due to nonspecific and atypical presentation. Diagnostic algorithms able to rule out PE and validated in young adult patients may have reduced applicability in elderly patients, which increases the number of diagnostic tools use and costs. The aim of the present study was to analyze the reported clinical presentation of PE in patients aged 65 and more. Prospective and retrospective English language studies dealing with the clinical, instrumental and laboratory aspects of PE in patients more than 65 and published after January 1987 and indexed in MEDLINE using keywords as pulmonary embolism, elderly, old, venous thromboembolism (VTE) in the title, abstract or text, were reviewed. Dyspnea (range 59%-91.5%), tachypnea (46%-74%), tachycardia (29%-76%), and chest pain (26%-57%) represented the most common clinical symptoms and signs. Bed rest was the most frequent risk factor for VTE (15%-67%); deep...
Circulation: Cardiovascular Quality and Outcomes, 2010
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). Methods and 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%/patie...