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August 17, 2020

Study Finds Rising Death Rates From Pulmonary Embolism

August 17, 2020—The American Heart Association (AHA) announced that after approximately a decade of steady decline, the mortality rate for patients with pulmonary embolism (PE) has risen during the past decade. This finding was shown in an investigation published by Karlyn A. Martin, MD, et al online ahead of print in Journal of the American Heart Association.

According to the AHA, the study found that death rates for PE had dropped an average of 4.4% per year from 1999 to 2008, then began climbing an average of 0.6% per year. The biggest increases were for patients age < 65 years.

“Death rates for PE are rising and seem to be doing so across age, race, and geographic regions,” commented Dr. Martin in the AHA announcement.

Dr. Martin, who is Assistant Professor of Medicine in the Division of Hematology/Oncology at Northwestern University’s Feinberg School of Medicine in Chicago, Illinois, continued, “We know that (PE and deep vein thrombosis [DVT]) are more common as people get older. So, we expected there to be higher rates in older people. But we found a significant number of younger people dying from PE as well. We don't know what's causing it, but it’s a worrisome trend that needs a dedicated study to find out why.”

According to the AHA, the investigators found premature and preventable deaths from PE increased 23% from 2008 to 2018 among patients ages 25 to 64 years, a trend that mirrors a rise in deaths from all causes among this age group.

The study did not address why racial disparities existed but observed that White men showed the highest increase in PE mortality rates, but that the death rate for Black men and women was consistently higher than that of White men and women over the past 2 decades.

“These data, for the first time, describe an alarming trend that is impacting Black Americans in particular,” stated Mary Cushman, MD, in the AHA press release. “It is very hard to determine the cause, apart from speculation.” Dr. Cushman is Medical Director of the Thrombosis and Hemostasis Program at the University of Vermont Medical Center in Burlington Vermont.

Dr. Cushman, who was not involved in the current study, chaired the writing group of a joint scientific statement from the AHA and the International Society on Thrombosis and Haemostasis (ISTH) identifying five top priorities for research on venous thromboembolism published July 8 online in ISTH’s Research and Practice in Thrombosis and Haemostasis and AHA’s Circulation.

Previously, Dr. Cushman led an investigation that found severe obesity to be a stronger risk factor for PE than DVT, suggesting “the continued rise in obesity may be playing a role. Other lifestyle factors like sedentary behavior, which is also on the rise, might be at play. But the rising rate in younger adults is a mystery to me and requires further study.” That study was published in August 2016 in Thrombosis Research (2016;144:127-132). She called the study “a wake-up call that we are going in the wrong direction.”

That means, Dr. Martin commented in the AHA press release, current efforts to prevent or treat PE do not seem to be working to keep death rates down, “We need to know what's underlying the drivers to prevent this and stop it from rising further.”

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