Abstract 18977: Trends in Use of Thrombolytic Therapy Among Fee-For-Service Medicare Beneficiaries With Acute Pulmonary Embolism
Background: Thrombolytic therapy may improve the outcomes of select patients with acute pulmonary embolism (PE); however, it has historically rarely been used in older adults. Contemporary national trends in use of thrombolytic therapy among elderly patients with PE are not known.
Methods: Using the inpatient Medicare Standard Analytic Files, we identified all Fee-For-Service patients aged ≥65 years old with a principal discharge diagnosis of PE between 1999 and 2010 and also identified those who received thrombolytic therapy. We used the Vital Status Files to determine rates of 30-day and 1-year mortality and fitted mixed-effects models to calculate adjusted mortality.
Results: During the study period, there were 545,131 patients with a principal discharge diagnosis of PE, of whom 7158 (1.3%) received thrombolysis. The number of PE patients undergoing thrombolysis increased from 380 in 1999 to 840 in 2010 (P<0.001 for linear trend), in large part owing to increased utilization among patients 65-74 years. The proportion of patients with PE receiving thrombolysis changed from 12 per 1000 in 1999 to 16 per 1000 in 2010 (p=0.09 for linear trend). In-hospital mortality rates among patients receiving thrombolysis ranged between 15% and 21.2% in the study period. Adjusted 30-day and 1-year mortality rates ranged between 17.9% to 23% and 26.1% to 31.4% across the years.
Conclusions: Recent trials (e.g., PEITHO) suggest thrombolysis may confer benefits in PE, even among older adults. We observed more widespread use in older age groups in recent years, but thrombolysis is still rarely applied for elderly patients compared with other age groups.
- © 2013 by American Heart Association, Inc.