Clinical presentation and outcomes in elderly patients with symptomatic isolated subsegmental pulmonary embolism.

Stoller, Nina; Limacher, Andreas; Méan Pascual, Marie; Baumgartner, Christine; Tritschler, Tobias; Righini, Marc; Beer, Jürg-Hans; Rodondi, Nicolas; Aujesky, Drahomir (2019). Clinical presentation and outcomes in elderly patients with symptomatic isolated subsegmental pulmonary embolism. Thrombosis research, 184, pp. 24-30. Elsevier 10.1016/j.thromres.2019.10.008

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OBJECTIVES

Data are limited on clinical presentation and outcomes in elderly patients with acute symptomatic isolated subsegmental pulmonary embolism (SSPE). We compared clinical presentation, risk factors, processes of care, and outcomes between elderly patients with SSPE and patients with more proximal pulmonary embolism (PE).

METHODS

We prospectively followed 578 patients aged ≥65 years with acute symptomatic isolated SSPE or proximal PE in a multicentre Swiss cohort study. We compared quality of life at three months using the PEmb-QoL, and examined the independent association between localization of PE and clinical outcomes (recurrent venous thromboembolism [VTE], overall mortality) using regression models with adjustment for potential confounders.

RESULTS

Overall, 11% of patients had isolated SSPE. Patients with SSPE were less likely to have a pulse ≥110/min (3% vs. 13%), but more likely to have active cancer (28% vs. 15%) and to receive outpatient care (11% vs. 4%) than patients with proximal PE. Virtually all patients (98%) with SSPE received anticoagulants. Quality of life did not differ between the groups at 3 months. No patient with SSPE vs. seven patients with proximal PE died from the index PE event. No significant difference was observed for the 3-year cumulative incidence of recurrent VTE (7% vs. 12%) and death (29% vs. 20%). After adjustment, SSPE was not associated with a lower risk of clinical outcomes than proximal PE.

CONCLUSIONS

Clinical presentation and incidences of adverse outcomes did not differ significantly between elderly patients with SSPE or proximal PE, although the power to detect differences might have been limited given the small number of events. Thus, our study does not provide evidence that unselected, elderly patients with SSPE have a more benign clinical course.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of General Internal Medicine (DAIM) > Clinic of General Internal Medicine
04 Faculty of Medicine > Department of General Internal Medicine (DAIM) > Clinic of General Internal Medicine > Centre of Competence for General Internal Medicine
04 Faculty of Medicine > Medical Education > Institute of General Practice and Primary Care (BIHAM)
04 Faculty of Medicine > Pre-clinic Human Medicine > CTU Bern

UniBE Contributor:

Stoller, Nina; Limacher, Andreas; Méan Pascual, Marie; Baumgartner, Christine; Tritschler, Tobias; Rodondi, Nicolas and Aujesky, Drahomir

Subjects:

600 Technology > 610 Medicine & health
300 Social sciences, sociology & anthropology > 360 Social problems & social services

ISSN:

0049-3848

Publisher:

Elsevier

Funders:

[4] Swiss National Science Foundation

Language:

English

Submitter:

Doris Kopp Heim

Date Deposited:

07 Nov 2019 15:00

Last Modified:

23 Oct 2020 02:30

Publisher DOI:

10.1016/j.thromres.2019.10.008

PubMed ID:

31683107

Uncontrolled Keywords:

Aged Anticoagulants Patient outcome assessment Pulmonary embolism Venous thromboembolism

BORIS DOI:

10.7892/boris.134739

URI:

https://boris.unibe.ch/id/eprint/134739

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