Occurrence of pulmonary embolism among 260 in-patients of acute geriatric department aged 65+ years in 2005-2010.

UNLABELLED Pulmonary embolism (PE) is after myocardial infarction and cerebrovascular events the third most frequent cardiovascular cause of death. Simultaneously it belongs to at least often correctly diagnosed cardiovascular diseases. THE AIM OF THE STUDY The retrospective analysis of 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 the study was a comparison of the data 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 we used following usual procedures (anamnesis, clinical examination, ECG, X-ray, labs etc.) also ECHO-cardiography, perfusion scan or helical CT of lungs. Eighty per cent of the deceased had an autopsy. In the set of in-patients with PE 89 died (34.2%) and 171 survived (65.8%) with anticoagulant treatment. RESULTS Prevalence of PE was 4.1% per year among all the hospitalized elderly in-patients (> or = 65 y.). Mortality among all the admitted patients to our department was 1.4%. Its occurrence was increasing with age to 81 y. and thereafter slightly decreasing. In one third of the deceased PE was an occasional finding in autopsy without any previous clinical signs. Mortality in the non-symptomatic group with PE in autopsy was significantly higher (chi2 = 57,293; p < 0.001). We didn't find any 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. We determined the age significant difference between survivors and the deceased--79.1 +/- 7.1 y. vs. 81.3 +/- 7.0 (t = 1.997; p < 0.05). Average duration of hospital stay was significantly different between both groups: the 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: the deceased and survivors. We found the most important risk factors in the group of the deceased immobility (p < 0.001) heart failure (p < 0.005) and stroke (p < 0.01). On the contrary in the survivor group there were more frequent risk factors obesity (p < 0.025); deep venous thrombosis (p < 0.025) and tumors (p < 0.05). Previous operations and traumas in the last month did not show any significant difference between both groups. Used treatment methods were evaluated, too. In the group of those who died multi-morbidity, often frailty and geriatric giants predominated even if the anticoagulant therapy was used comparably in both groups (survivors and the deceased). CONCLUSION We would like to emphasize the need to think permanently in elderly persons with present risk factors of the possibility of PE and also the requirement of correctly assessed diagnosis and starting therapeutic procedures as soon as possible.