A Comparison of Patients Diagnosed With Pulmonary Embolism Who Are ?65 Years With Patients <65 Years - 17/02/15
Abstract |
Recent studies have highlighted differences in how older patients respond to high-risk pulmonary embolism (PE) and treatment. However, guidelines for PE risk stratification and treatment are not based on age, and data are lacking for older patients. We characterized the impact of age on clinical features, risk stratification, treatment, and outcomes in a sample of patients with PE in the emergency department. We performed an observational cohort study of 547 consecutive patients with PE in the emergency department from 2005 to 2011 in an urban tertiary hospital. We used bivariate proportions and multivariable logistic regression to compare clinical presentation, risk category, treatment, and outcomes in patients ≥65 years with those <65 years. The mean age was 58 ± 17 years, 276 (50%) were women, and 210 (38%) were ≥65 years. PE was more severe in patients ≥65 years (massive 14% vs 5%, submassive 48% vs 25%, and low risk 38% vs 70%, p <0.0001), with submassive PE being the most common presentation in patients ≥65 years. However, subanalysis removing natriuretic peptides from the definition of submassive PE negated this finding. Treatment with parenteral anticoagulation (88% vs 90%, p = 0.32), thrombolytic therapy (5% vs 4%, p = 0.87), and inferior vena cava filter (4% vs 4%, p = 0.73) were similar among age groups. Patients ≥65 years had higher 30-day mortality (11% vs 3%, p <0.001). In conclusion, patients ≥65 years present with more severe PE and have higher mortality, although treatment patterns were similar to younger patients. Age-specific guideline definitions of submassive PE may better identify high-risk patients.
Le texte complet de cet article est disponible en PDF.Highlights |
• | Elderly patients present with more severe pulmonary embolism (PE). |
• | Elderly patients with PE have higher 30-day mortality than younger patients. |
• | Treatment patterns do not differ among age groups. |
• | Natriuretic peptides may not be accurate markers of PE severity in the elderly population. |
• | The guideline definition of submassive PE may need to be modified for the elderly population. |
Plan
See page 685 for disclosure information. |
Vol 115 - N° 5
P. 681-686 - mars 2015 Retour au numéroBienvenue sur EM-consulte, la référence des professionnels de santé.
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