Characteristics and clinical management of acute pulmonary embolism in real world: findings from TUSCAN-PE study

Abstract

Acute pulmonary embolism (PE) remains one of the leading causes of mortality and morbidity in cardiovascular setting. Despite much information about clinical aspects and recommendations or clinical guidelines is available from literature, few data exist about the management of PE in real world of internal medicine scenario. Therefore the aim of the present study was to report on characteristics and management of PE patients admitted in this setting. TUSCAN-PE study was a multicenter, observational, retrospective, cohort study aimed to analyze data of PE patients admitted in Internal Medicine wards of Tuscany. Each center was invited to submit anonymously data of at least ten patients consecutively discharged for acute PE in 2012. Data were referred to demographic, clinical, instrumental, prognostic and therapeutic characteristics. A total of 452 patients from 28 Tuscan centers (60.2% F), with mean age 76.01±12.34 years, were enrolled. A total of 87% of patients was admitted from Emergency Department, but only 65.2% of patients with diagnosis of PE. Around one third of diagnoses of PE was performed by internists. In 14.8% of diagnoses was incidental. In 86% of patients, diagnosis was performed by computer tomography pulmonary angiography. Overall mortality was 9.5%, 5.75% being PE-related. Main risk factors enclosed recent respiratory tract infections (55.3%), immobility (42.25%), recent hospital admissions (33.6%) and cancer (30.3%). In 65.8% of patients, PE was associated with deep vein thrombosis. 16.6% of patients had a shock index ≥1 and 84.75% simplified pulmonary embolism severity index (PESI) score ≥1. A number of 51.5% of patients presented echocardiographic right heart dysfunction, 50.6% and 55.9% of patients presented increased values of troponins and natriuretic peptides, respectively. The following percentage, 6.5%, 71.1% and 22.4%, were defined as high, intermediate and low risk according to the European Society of Cardiology (ESC) criteria, respectively. Antithrombotic treatment was started in Internal Medicine wards in 60.6% of patients. 4.9% of patients were treated with systemic thrombolysis, 15.1% with intravenous unfractionated heparin, whereas low molecular weight heparins and fondaparinux were performed in 39.2% and 39.8% of patients, respectively. Vitamin K antagonists were prescribed in 52.1% of patients at hospital discharge. Fatal and non-fatal major bleedings occurred in 1.7% of patients. TUSCAN-PE study contributes to the knowledge of real life management of acute PE in the Internal Medicine setting.