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National Trends in Pulmonary Embolism Hospitalization Rates and Outcomes for Adults Aged ≥65 Years in the United States (1999 to 2010)

https://doi.org/10.1016/j.amjcard.2015.07.068Get rights and content

Little is known about national trends of pulmonary embolism (PE) hospitalizations and outcomes in older adults in the context of recent diagnostic and therapeutic advances. Therefore, we conducted a retrospective cohort study of 100% Medicare fee-for-service beneficiaries hospitalized from 1999 to 2010 with a principal discharge diagnosis code for PE. The adjusted PE hospitalization rate increased from 129/100,000 person-years in 1999 to 302/100,000 person-years in 2010, a relative increase of 134% (p <0.001). Black patients had the highest rate of increase (174 to 548/100,000 person-years) among all age, gender, and race categories. The mean (standard deviation) length of hospital stay decreased from 7.6 (5.7) days in 1999 to 5.8 (4.4) days in 2010, and the proportion of patients discharged to home decreased from 51.1% (95% confidence interval [CI] 50.5 to 51.6) to 44.1% (95% CI 43.7 to 44.6), whereas more patients were discharged with home health care and to skilled nursing facilities. The in-hospital mortality rate decreased from 8.3% (95% CI 8.0 to 8.6) in 1999 to 4.4% (95% CI 4.2 to 4.5) in 2010, as did adjusted 30-day (from 12.3% [95% CI 11.9 to 12.6] to 9.1% [95% CI 8.5 to 9.7]) and 6-month mortality rates (from 23.0% [95% CI 22.5 to 23.4] to 19.6% [95% CI 18.8 to 20.5]). There were no significant racial differences in mortality rates by 2010. There was no change in the adjusted 30-day all-cause readmission rate from 1999 to 2010. In conclusion, PE hospitalization rates increased substantially from 1999 to 2010, with a higher rate for black patients. All mortality rates decreased but remained high. The increase in hospitalization rates and continued high mortality and readmission rates confirm the significant burden of PE for older adults.

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Methods

We identified 100% of Medicare fee-for-service beneficiaries (≥65 years) using 1999 to 2010 inpatient claims data from the Centers for Medicare and Medicaid Services (CMS) who had participated for at least 1 month in fee-for-service and resided and were hospitalized for PE from January 1, 1999 to December 31, 2010, in the United States. Hospitalizations for PE were defined as discharged from an acute-care hospital for a principal discharge diagnosis of PE according to the following the

Results

We identified 380,427,267 beneficiary records, representing 80,248,916 unique beneficiaries aged ≥65 years from 1999 to 2010 of which 545,243 were hospitalized for PE from January 1, 1999, and December 31, 2010. Detailed characteristics of patients hospitalized for PE are reported in Table 1.

The crude hospitalization rate for PE was 129 per 100,000 person-years in 1999, and after adjusting for age, gender, and race, the overall hospitalization rate gradually increased to 302 per 100,000

Discussion

To our knowledge, this is the largest study to date that examined the recent trends in PE hospitalization rates and outcomes across the United States in older adults. From 1999 to 2010, we found a substantial increase in the hospitalization rates for PE and concomitant decline in inhospital and risk-adjusted 30-day and 6-month mortality rates, length of stay, proportion of patients discharged to home, and stable risk-adjusted 30-day readmission rates for Medicare beneficiaries. Although the

Acknowledgment

The contents of the report are solely the responsibility of the authors and do not necessarily represent the official view of NIH.

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    Funding: This was supported by grant number U01 HL105270-05 from the National Heart, Lung, and Blood Institute at the National Institutes of Health.

    See page 1441 for disclosure information.

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