In-hospital PE deaths remain stable in US
MedWire News: The estimated annual number of in-hospital deaths among patients with a pulmonary embolism (PE) diagnosis has remained relatively stable during recent years, despite a decline in case-fatality rates, US study data show.
James Tsai and colleagues from the Centers for Disease Control and Prevention, in Atlanta, Georgia, say that recent data linked PE to approximately 247,000 hospitalizations in the USA in 2006, but data on the case-fatality rate and estimated number of in-hospital deaths among US patients with PE are limited.
Tsai and team therefore analyzed results of the US National Hospital Discharge Survey (NHDS) to calculate nationally representative estimates of in-hospital deaths (annual number and case-fatality rate) among patients hospitalized with a PE diagnosis between 2001 and 2008.
They used International Classification of Diseases, Ninth Revision, Clinical Modification codes to identify patients with "first-listed" and "any-listed" PE, where the first-listed code indicates a principal diagnosis.
The researchers found that the case-fatality rates for first-listed PE declined linearly across four defined time periods, from 5.9% in 2001 to 2002, to 4.2% in 2003 to 2004, 3.8% in 2005 to 2006, and 2.4% in 2007 to 2008. For any-listed PE the case-fatality rates fell from 11.4%, to 7.8%, 7.8%, and 7.1%, respectively.
Despite these declines in case-fatality rates in hospitalizations related to PE, Tsai and team did not generally find a corresponding reduction in the numbers of in-hospital deaths.
Indeed, the estimated annual numbers of in-hospital deaths among patients with first-listed PE were 5870, 5140, 5440, and 3600 during 2001 to 2002, 2003 to 2004, 2005 to 2006, and 2007 to 2008, respectively.
For any-listed PE the corresponding figures were 17,920, 14,870, 17,600, and 18,560.
"Although the exact reasons for the decline in case-fatality rates were unknown and may warrant further investigation, the decrease may be multifaceted and could be attributable to a combination of an increased number of PE diagnoses resulting from improved diagnostic techniques together with more effective treatment and fewer complications," the researchers remark.
They conclude in the Archives of Internal Medicine: "As the US population is aging, reducing the number of in-hospital deaths from PE and improving patients' quality of life are important clinical and public health goals and pose a formidable challenge for the health care systems."
By Laura Cowen