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In-hospital mortality and reperfusion rate in octagenarians with high-risk pulmonary embolism: a nationwide population-based cohort study in Portugal from 2010 to 2018
Session:
Comunicações Orais - Sessão 20 - Tromboembolismo pulmonar agudo
Speaker:
Rita Calé
Congress:
CPC 2023
Topic:
F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme:
21. Pulmonary Circulation, Pulmonary Embolism, Right Heart Failure
Subtheme:
21.7 Pulmonary Circulation, Pulmonary Embolism, Right Heart Failure - Other
Session Type:
Comunicações Orais
FP Number:
---
Authors:
Rita Calé; Raquel Ascenção; Carolina Bulhosa; Helder Pereira; Margarida Borges; João Costa; Daniel Caldeira
Abstract
<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:"Times New Roman",serif"><span style="color:#000000"><strong>Background: </strong>Reperfusion is the standard treatment<strong> </strong>in high-risk pulmonary embolism (HR-PE) to unload right ventricle and prevent mortality. However, several registries report reperfusion underuse and elderly patients are often undertreated due to the fear of bleeding with thrombolysis.<strong> </strong>The aim of this study was to assess<strong> </strong>in Portugal,<strong> </strong>epidemiological data about the rate of reperfusion and mortality of HR-PE in octogenarians (<u>></u>80 years-old). </span></span></span></p> <p style="text-align:justify"><span style="font-size:medium"><span style="font-family:"Times New Roman",serif"><span style="color:#000000"><strong>Methods: </strong>nationwide population-based temporal trend study on the outcome of HR-PE in octagenarians who were admitted in hospitals of the National Health Service in Portugal between 2010 and 2018. International Classification of Diseases (ICD), 9<sup>th</sup> and 10<sup>th</sup> revision, were used. HR-PE was defined as patients with PE who developed shock or cardiac arrest. Patients were divided in two groups: O- octagenarians (<u>></u> 80 years) and C- control group (18-79 years-old).</span></span></span></p> <p style="text-align:justify"><span style="font-size:medium"><span style="font-family:"Times New Roman",serif"><span style="color:#000000">Trends in the use of reperfusion treatment, defined by use of thrombolysis or pulmonary embolectomy, and trends in in-hospital mortality were assessed. Multivariate regression analysis was performed to evaluate the independent predictors to in-hospital mortality.</span></span></span></p> <p style="text-align:justify"><span style="font-size:medium"><span style="font-family:"Times New Roman",serif"><span style="color:#000000"><strong>Results: </strong>From 2010-2018, 1696 pts were hospitalized for HR-PE (group O- 447pts; group C- 1249pts). The mortality in octogenarians with HR-PE was very high and has not significantly decreased over the years (73.1% in 2010 to 61.5% in 2018; R<sup>2</sup>=-0.135; p=0.829; figure 1). The in-hospital mortality is on average 10% higher compared to group C (71.1% vs 60.9%; p=0.001). Reperfusion therapy (all with systemic thrombolysis) was underuse in octogenarians, but its use has been increasing over the last few years (7.7% in 2010 to 26.9% in 2018, R<sup>2</sup>=0.484; p=0.022). There was no registry of surgical pulmonary embolectomy or catheter-directed therapy in group O. There was 1.5% (1 in 68 patients) of intracranial bleeding in octogenarians with HR-PE submitted to thrombolysis (versus 2,5% in group C; p=0.597). In octogenarians, in-hospital mortality was significantly lower in pts who received thrombolytic treatment (52.9% vs 74.2%; p=0.0004). The independent predictors to in-hospital mortality were age (OR 1.02; 95%CI 1.1-1.02); Charlson Comorbidity Index (OR 1.09; 95%CI 1.04-1.13) and reperfusion (OR 0.56; 95%CI 0.44-0.72).</span></span></span></p> <p style="text-align:justify"><span style="font-size:medium"><span style="font-family:"Times New Roman",serif"><span style="color:#000000"><strong>Conclusion: </strong>In Portugal, systemic thrombolysis in octogenarians was underuse nevertheless its use has been increasing over the last few years. Thrombolytic therapy is associated with lower mortality in elderly with acceptable risk of intracranial bleeding.</span></span></span></p>
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