Kardiologia polska · 2025
Trends in the incidence and treatment of pulmonary embolism in Poland (2018-2023): Insights from public healthcare data.
СтатьяПоддержка службы здравоохранения СШАНазвание и аннотация: Перевод в очереди
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Pruszczyk Piotr, Araszkiewicz Aleksander, Chrzanowski Łukasz, Dzikowska-Diduch Olga, Kopeć Grzegorz, Kruszelnicka-Kwiatkowska Olga, Kuliczkowski Wiktor, Kurzyna Marcin, Lewicka Ewa, Roik Marek, Sobkowicz Bożena, Undas Anetta, Stus Marcin, Kowalska Anna, Stachurski Tomasz
Аннотация
BACKGROUND: There are limited epidemiological data on the incidence and prognosis of acute pulmonary embolism (PE) in Poland.
MATERIAL AND METHODS: We assessed the incidence of PE, its therapies, and all-cause mortality in Poland in the years 2018-2023 using the administrative national health care database.
RESULTS: The number all PE hospitalizations ranged from 16 641 cases in 2020 to 25 363 patients in 2021. Recurrent PE accounted for 5.9% of all PE cases. The mean annual hospitalization rate for PE, used as an estimate of PE incidence, was 56 per 100 000 population, from 49/100 000 in 2018 to 62/100 000 in 2023, with trend to statistical significance (P = 0.059). The average in-hospital mortality rate during the 6-year period was 13% (SD 0.97) and was the highest during COVID-19 pandemic years, exceeding 14% (P <0.01). Cumulative all-cause mortality (in the years 2018-2023) at 12 months averaged 31.1% (SD 1.55%). Women presented higher in-hospital and one-year mortality when compared to men (P <0.001). In patients free of malignancy and COVID-19, one-year mortality was 23.3%, while when neoplasm coexisted, it exceeded 50%. The majority of patients were anticoagulated only. Thrombolysis or surgical embolectomy were used infrequently (<1% of patients); however, we observed a progressive increase of percutaneous therapies. Direct oral anticoagulants after the discharge were prescribed in 73.1% of patients. However, 3.8% of patients discharged did not purchase the recommended prescription. This non-adherent subgroup showed at 1 year a 2.6 -fold higher mortality risk compared to subjects adherent to anticoagulation (HR, 2.59; 95% CI, 2.441-2.750; P <0.001).
CONCLUSION: A lower estimated annual PE incidence in Poland of 60/100 000 persons when compared to recent European data suggesting suboptimal PE diagnosis and high all-cause in-hospital and one-year mortality rates necessitate improvement of PE diagnosis and management. Moreover, our data showed that women with PE may have worse prognosis than men and that non-adherence to anticoagulation significantly reduces one-year post-discharge survival.
MATERIAL AND METHODS: We assessed the incidence of PE, its therapies, and all-cause mortality in Poland in the years 2018-2023 using the administrative national health care database.
RESULTS: The number all PE hospitalizations ranged from 16 641 cases in 2020 to 25 363 patients in 2021. Recurrent PE accounted for 5.9% of all PE cases. The mean annual hospitalization rate for PE, used as an estimate of PE incidence, was 56 per 100 000 population, from 49/100 000 in 2018 to 62/100 000 in 2023, with trend to statistical significance (P = 0.059). The average in-hospital mortality rate during the 6-year period was 13% (SD 0.97) and was the highest during COVID-19 pandemic years, exceeding 14% (P <0.01). Cumulative all-cause mortality (in the years 2018-2023) at 12 months averaged 31.1% (SD 1.55%). Women presented higher in-hospital and one-year mortality when compared to men (P <0.001). In patients free of malignancy and COVID-19, one-year mortality was 23.3%, while when neoplasm coexisted, it exceeded 50%. The majority of patients were anticoagulated only. Thrombolysis or surgical embolectomy were used infrequently (<1% of patients); however, we observed a progressive increase of percutaneous therapies. Direct oral anticoagulants after the discharge were prescribed in 73.1% of patients. However, 3.8% of patients discharged did not purchase the recommended prescription. This non-adherent subgroup showed at 1 year a 2.6 -fold higher mortality risk compared to subjects adherent to anticoagulation (HR, 2.59; 95% CI, 2.441-2.750; P <0.001).
CONCLUSION: A lower estimated annual PE incidence in Poland of 60/100 000 persons when compared to recent European data suggesting suboptimal PE diagnosis and high all-cause in-hospital and one-year mortality rates necessitate improvement of PE diagnosis and management. Moreover, our data showed that women with PE may have worse prognosis than men and that non-adherence to anticoagulation significantly reduces one-year post-discharge survival.