Treatment of Pulmonary Embolism among 260 In-patients of Acute Medical Department in Elderly Persons

D Weberova, P Weber, H Kubesova, H Meluzinova, V Polcarova, P Canov. Faculty Hospital and Masaryk University, Dept. of Internal Medicine, Geriatrics and Practical Medicine, Czech Republic

Introduction: Pulmonary embolism (PE) is after myocard infarction and cerebrovascular events third oftenest cardiovascular cause of death. Simultaneously belongs among at least often correctly diagnosed cardiovascular diseases. Aim of the study: The retrospective analysis from the database of inpatients with the target assess the clinical course of PE according to prevalence, mortality, average duration of stay, risk factors, used diagnostic methods and kinds of therapy. Another aim of study was a comparison the dates among the survivors and deceased persons. Patient’s set and method: Between 2005 and 2010 years we had altogether 6,323 elderly patients of an average age 80.7±6.9 y. (range 65-103 y.) treated at the Department of Geriatrics. Out of this number there were 4,163 women (66%) and 2,160 men (34%). We evaluated the course of PE in 260 cases of mean age 79.8±7.2 y. (165 women and 95 men). For the verification of the diagnosis of PE were used next usual proceedings (anamnesis, clinical examination, ECG, X-ray, labs etc.) also ECHO-cardiography, perfusion scan or helical CT of chest. Eighty per cent of deceased hade autopsy. In the set in-patients with PE 89 died (34.2%) and 171 (65.8%) survive with anticoagulant treatment and discharged from the department. Results: Prevalence of PE was 4.1% per year among all hospitalized elderly in-patients (≥ 65 y.). Its occurrence was increasing with age to 81 y. and thereafter slightly decreasing. 89 of all above mentioned persons with PE died on PE. In one third of deceased was PE occasional finding in autopsy without any previous clinical signs. Mortality in asymptomatic persons was significantly higher in comparison to patients wit symptomatic PE (χ2= 57,293; p<0.001). We didn’t find significant gender difference in prevalence of mortality according to gender structure of the set with PE. In 14 cases PE clinically demonstrated as sudden death. But we determined the age difference between deceased - 82.6±7.1 y. vs. 79.9±6.7 (t=4.327; p= 0.01). Average duration of hospital stay was also significantly different between both groups: deceased 9.2±9.6 vs. 12.4±7.4 in survivors (t=4.256; p-0.01). Risk factors were assessed and compared between both groups: deceased and survivors. We found as the most important risk factor in group of deceased immobility (p<0,005), heart failure (p<0,01) a stroke (p<0,01); while in survivor’s group was more frequent risk of PE– obesity (p<0,025), deep vein thrombosis (p<0,025) and presence of tumors (p<0,05). Previous surgery in the last month and trauma did not show differences between the two groups of survivors and deceased. Used treatment methods were evaluated too. Conclusion: We would like to emphasize the need permanently think in elderly persons with present risk factors on the possibility of PE and also the requirement of correctly assessed diagnosis and start therapeutic procedures as soon as possible.