Previous studies have suggested that the incidence of acute PE is higher in women than men among those aged 55 and younger, but research is still lacking with regard to patient outcomes gender disparities.
Acute pulmonary embolism (PE) is a form of venous thromboembolism that is common among patients in the United States and can be life-threatening. The clinical presentation of PE varies and is often non-specific, making its diagnosis challenging for physicians.
In an effort to overcome this research gap, Venu Menon, MD, and colleagues had a study published in the American Journal of Cardiology that assessed gender-specific rates and trends in treatment, outcomes, and complications after acute PE. Using the 2003 to 2011 Nationwide Inpatient Sample database, the investigators identified all hospital admissions with a principal diagnosis of acute PE. In-hospital mortality and discharge to a nursing facility were the primary outcomes of the study. Secondary outcomes included shock, transfusion of blood products, utilization of thrombolysis, placement of an inferior vena cava filter, and cost of hospitalization.
Over the 9-year duration of the study, researchers identified more than 276,000 acute PE discharges. “When compared with men, women who were admitted to the hospital with acute PE had a significantly higher in-hospital mortality rate,” says Dr. Menon. “In addition, women were significantly more likely than men to require discharge to a nursing facility.” He noted that women who were older, had more comorbidities, and lived alone were at greater risk than others for acute PE.
When looking at secondary outcomes, the analysis revealed that women with acute PE were more likely than men to need a transfusion of blood products or to experience shock during their hospitalization. The research team also observed significantly lower utilization of vena cava filters in women when compared with men.
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Dr. Menon and colleagues also examined if patients with acute PE who were in shock were eligible for thrombolysis. These criteria included: 1) age older than 75 years; 2) no previous stroke; 3) no bleeding on presentation; and 4) not being pregnant. Among these patients, the utilization of thrombolysis was similar between men and women. The study group also found that the cost of hospitalization after acute PE was significantly higher for men than women, with an adjusted average difference of about $425.
“Overall, our study suggests that women admitted with acute PE tended to have more adverse outcomes and a higher incidence of complications than men,” Dr. Menon says. “Our research provides clarity on the extra risks that women experience and should serve as a warning sign for clinicians to be aggressive with treatments should acute PE be suspected.”
According to Dr. Menon, it is critical to validate these findings in future investigations that are more rigorous in nature. “We need to determine if gender disparities in acute PE persist in real-world settings,” he says. “With confirmation of our findings, we may gain a better understanding of important signals for each gender. We can then tailor our treatment strategies and help patients avoid the life-threatening consequences of acute PE.”
Readings & Resources (click to view)
Agarwal S, Clark III D, Sud K, Jaber WA, Cho L, Menon V. Gender disparities in outcomes and resource utilization for acute pulmonary embolism hospitalizations in the United States. Am J Cardiol. 2015;116:1270-1276. Available at: http://www.sciencedirect.com/science/article/pii/S0002914915017087.
Yoo HH, Queluz TH, El Dib R. Outpatient versus inpatient treatment for acute pulmonary embolism. Cochrane Database Syst Rev. 2014;11:CD010019.
Agarwal S, Menon V, Jaber WA. Residential zip code influences outcomes following hospitalization for acute pulmonary embolism in the United States. Vasc Med. 2015;20:439-446.