OC 14.1 - Time trends in prognosis of pulmonary embolism in The Netherlands (2013-2018)

Background: An update at nationwide level is warranted as inconsistent time trends in prognosis of pulmonary embolism (PE) have been reported in the Western world, which is relevant for both patients and physicians.

Aims: To assess time trends in prognosis of PE in The Netherlands (2013-2018).

Methods: With nationwide data from Statistics Netherlands, incident (hospitalized) PE patients (ICD-10 code: I26) diagnosed between 1/1/2013 and 31/12/2018 were identified and categorized in six cohorts (i.e., Cohort 2013-Cohort 2018) according to the calendar year of the diagnosis. All patients were followed until 31/12/2019 (or death) to estimate cumulative incidences of all-cause mortality and major bleeding. Cox regression was employed to evaluate differences in outcomes between cohorts with adjustment for confounding. Age-and-sex-standardized annual PE-related mortality rates were also calculated, defined as numbers of PE-related deaths (on the basis of death certificates) divided by age-and-sex-standardized number of Dutch inhabitants in each calendar year.

Results: 61,322 incident PE patients were identified, of whom 12% also had deep vein thrombosis. The sizes and baseline characteristics were similar between cohorts (i.e., mean age 65±16 years; male≈49%; three most prevalent comorbidities: cancer (≈28%), hypertension (≈22%), and diabetes (≈13%)). Overall, the 30-day, 90-day, 180-day, 1-year, and 5-year cumulative incidences of all-cause mortality were 10%, 16%, 20%, 24%, and 39%, respectively; the 30-day and 180-day cumulative incidences of major bleeding were 5% and 6%, respectively. Between cohorts, the more recent cohorts saw the higher cumulative incidences of all outcomes, but hazard ratios were not statistically significant after adjustment (Table). No significant difference was observed in standardized annual PE-related mortality rates (2013-2018). The crude annual PE-related mortality rates increased with age but were similar between sex (Figure).

Conclusion(s): The prognosis of PE, evaluated by short- or long-term case-fatality-rate, major bleeding, and standardized PE-related mortality rates, remained constant in The Netherlands between 2013 and 2018.