Sex Differences in Management and Outcomes Among Patients With High-Risk Pulmonary Embolism: A Nationwide Analysis |
| |
| Affiliation: | 1. Department of Medicine, Albert Einstein Medical Center, Philadelphia, PA, USA;2. Division of Cardiology, Henry Ford Hospital, Detroit, MI, USA;3. Section of Cardiology, Baylor College of Medicine, Houston, TX, USA;4. Department of Medicine, Ascension Macomb-Oakland Hospital, Warren, MI, USA;5. Division of Cardiology, Massachusetts General Hospital, Boston, MA, USA;6. Division of Cardiology, University of Arizona-College of Medicine, Phoenix, AZ, USA;7. Division of Cardiovascular Medicine, Gill Heart Institute, University of Kentucky, Lexington, KY, USA;1. Department of Neurologic Surgery, Mayo Clinic, Rochester MN;2. Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester MN;3. Department of Otolaryngology–Head and Neck Surgery, Mayo Clinic, Rochester MN;4. Department of Radiation Oncology, Mayo Clinic, Rochester MN;5. Department of Quantitative Health Sciences, Mayo Clinic, Rochester MN;1. Providence Medical Research Center, Providence Health Care, University of Washington, Spokane and Seattle;2. David Geffen School of Medicine at University of California, Los Angeles;1. Department of Kinesiology & Health Sciences, College of Humanities & Sciences, Virginia Commonwealth University, Richmond, VA;2. VCU Pauley Heart Center, Division of Cardiology, Department of Internal Medicine, Virginia Commonwealth University, Richmond, VA;3. Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL;4. John Ochsner Heart and Vascular Institute, Ochsner Clinical School-the University of Queensland School of Medicine, New Orleans, LA;1. Knowledge and Evaluation Research Unit, Department of Medicine, Mayo Clinic, Rochester, MN;2. Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN;3. Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN;4. Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN;5. Center for Clinical and Translational Science;6. Department of Orthopedic Surgery (H.M.K.), Mayo Clinic, Rochester, MN;1. Service de médecine interne et vasculaire, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Pierre-Bénite, France;2. Lyon immunopathology Federation (LIFe), Hospices Civils de Lyon, Lyon, France;3. Service de pharmacotoxicologie, Hospices Civils de Lyon, Lyon, France;4. Université de Lyon, Université Lyon 1, CNRS, Laboratoire de Biométrie et Biologie Evolutive UMR 5558, Villeurbanne, France;5. Service de médecine interne, Hôpital Estaing, Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France;6. Service de court séjour gériatrique, Hôpital des Charpennes, Hospices Civils de Lyon, Villeurbanne, France;7. Université de Lyon, Université Lyon 1, Health Services and Performance Research EA7425, Lyon, France;8. Service de médecine interne et d’immunologie clinique, CHU Dijon Bourgogne, Hôpital François Mitterrand, Dijon, France |
| |
| Abstract: | ObjectiveTo examine the sex differences in management and outcomes among patients with high-risk acute pulmonary embolism (PE).Patients and MethodsThe Nationwide Readmissions Database was used to identify hospitalizations with high-risk PE from January 1, 2016, to December 31, 2018. Differences in use of advanced therapies, in-hospital mortality, and bleeding events were compared between men and women.ResultsA total of 125,901 weighted hospitalizations with high-risk PE were identified during the study period; 46.3% were women (n=58,253). Women were older and had a higher prevalence of several comorbidities and risk factors of PE such as morbid obesity, diabetes mellitus, chronic pulmonary disease, heart failure, and metastatic cancer. Systemic thrombolysis and catheter-directed interventions were more commonly used among women; however, mechanical circulatory support was less frequently used. In-hospital mortality was higher among women in the unadjusted analysis (30.7% vs 27.8%, P<.001) and after propensity score matching (odds ratio [OR], 1.16; 95% confidence interval [CI], 1.08 to 1.25; P<.001), whereas the rates of intracranial hemorrhage and non–intracranial hemorrhage were not different. On multivariate regression analysis, female sex (OR, 1.18; 95% CI, 1.15 to 1.21; P<.001) was independently associated with increased odds of in-hospital mortality.ConclusionIn this contemporary observational cohort of patients admitted with high-risk PE, women had higher rates of in-hospital mortality despite receiving advanced therapies more frequently, whereas the rate of major bleeding events was not different from men. Efforts are needed to minimize the excess mortality observed among women. |
| |
| Keywords: | CDE" },{" #name" :" keyword" ," $" :{" id" :" kwrd0015" }," $$" :[{" #name" :" text" ," _" :" catheter-directed embolectomy CDI" },{" #name" :" keyword" ," $" :{" id" :" kwrd0025" }," $$" :[{" #name" :" text" ," _" :" catheter-directed intervention CDT" },{" #name" :" keyword" ," $" :{" id" :" kwrd0035" }," $$" :[{" #name" :" text" ," _" :" catheter-directed thrombolysis ICH" },{" #name" :" keyword" ," $" :{" id" :" kwrd0045" }," $$" :[{" #name" :" text" ," _" :" intracranial hemorrhage MCS" },{" #name" :" keyword" ," $" :{" id" :" kwrd0055" }," $$" :[{" #name" :" text" ," _" :" mechanical circulatory support NRD" },{" #name" :" keyword" ," $" :{" id" :" kwrd0065" }," $$" :[{" #name" :" text" ," _" :" Nationwide Readmissions Database OR" },{" #name" :" keyword" ," $" :{" id" :" kwrd0075" }," $$" :[{" #name" :" text" ," _" :" odds ratio PE" },{" #name" :" keyword" ," $" :{" id" :" kwrd0085" }," $$" :[{" #name" :" text" ," _" :" pulmonary embolism US-CDT" },{" #name" :" keyword" ," $" :{" id" :" kwrd0095" }," $$" :[{" #name" :" text" ," _" :" ultrasound-facilitated catheter-directed thrombolysis |
| 本文献已被 ScienceDirect 等数据库收录！ |
|
