Management of Pulmonary Embolism With and Without Right Heart Failure

Author Type(s)

Faculty, Resident/Fellow

Document Type

Abstract

Publication Date

2022

DOI

10.1016/j.jacc.2022.08.267

Journal Title

Journal of the American College of Cardiology

Department

Medicine

Abstract

Background: Pulmonary embolism (PE) is often associated with right ventricular strain and right heart failure (RHF). There are limited reports of PE outcomes in patients with RHF because of limited sample size. Therefore we used nationwide data to assess the prevalence and outcomes of RHF with PE. Methods: Data from the 2018-2019 National Inpatient Sample were collected in patients presenting with PE. International Classification of Diseases codes were further used to identify patients with RHF. Our outcomes of interest were inpatient mortality and complications. Survey-specific techniques (chi-square test and t-test) were used for all analyses in Stata version 16.0. Predictors of RHF were identified using a multivariable logistic regression model. Results: A total of 11,480 patients (1.5%) had concomitant RHF among all patients presenting with PE. The mean age was similar at 62.5 years in patients with and those without RHF. Patients with RHF were more likely to be women (53.5% vs 51.3%; P = 0.03), had a greater prevalence of hypertension (66.7% vs 60.9%), atrial fibrillation (21.5% vs 14.9%), chronic kidney disease (21.1% vs 15.1%), liver disease (14.0% vs 6.8%), and peripheral vascular disease (34.3% vs 27.4%) (P < 0.01 for all) but similar histories of coronary artery disease (17.0% vs 18.1%; P = 0.18). Use of extracorporeal membrane oxygenation was more frequent in patients with RHF (2% vs 0.2%; P < 0.01). Other complications, such as cardiac arrest (6.9% vs 2.5%), cardiogenic shock (15.9% vs 1.8%), extended ventilator use (20.7% vs 8.2%), and vasopressor use (7.6% vs 2.1%), were also significantly more frequent in patients with RHF. In-hospital mortality was more than double in patients with RHF (15.7% vs 6.5%; P < 0.05). In a multivariable-adjusted model, RHF was significantly associated with higher mortality, with an adjusted OR of 1.87 (95% CI: 1.64-2.13; P < 0.01). Predictors of RHF included female gender (adjusted OR: 1.23; 95% CI: 1.13-1.35), liver disease (adjusted OR: 1.48; 95% CI: 1.30-1.70), and obesity (adjusted OR: 1.36; 95% CI: 1.22-1.50) (P < 0.05 for all). Conclusions: RHF adds to significant morbidity and mortality burden in patients presenting with PE. Female gender, obesity, and liver disease are predictors of RHF in these patients. In-hospital mortality is nearly double in patients with concomitant RHF. Categories: ENDOVASCULAR: Pulmonary Embolism and Pulmonary Hypertension

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