Admitting clinical department effect on outcomes for acute pulmonary embolism
Authors: Farmakis I , Keller K , Barco S , Valerio L , Tichelbaecker T , Partovi S , Fengler K , Vosseler M , Lurz P , Konstantinides S V , Hobohm L 
Published: October 2024

Abstract

Background
Pulmonary embolism (PE) is the third most fatal cardiovascular disease and its management is often complex requiring multidisciplinary involvement.

Aims
To investigate whether there are differences between patient populations with acute PE and associated outcomes admitted to different clinical departments based on a German nationwide inpatient population.

Methods
We used the German nationwide inpatient sample to identify hospitalizations of patients with acute PE within the period 2005-2020. Patients were classified according to the department were they spent the longest duration of hospitalization (cardiology, general internal medicine, or pulmonology/critical care medicine). Patients admitted and treated to other departments were excluded from the analysis. Temporal trends of hospitalizations, as well as the impact of admitting departments on case-fatality were investigated with the cardiology department used as reference and after multivariable adjustment for age, sex, and comorbidities (source: RDC of the Federal Statistical Office and the Statistical Offices of the federal states, DRG Statistics 2005-2020, own calculations).

Results
During the investigated period a total of 759,115 patients with acute PE were identified; of those 117,501 (15.5%) were admitted to cardiology, 37,726 (5.0%) were admitted to pulmonology/critical care, while the majority of 603,888 (79.5%) were admitted to internal medicine (Table 1). A trend towards increasing number of patients admitted to cardiology in recent years was observed as opposed to being admitted to internal medicine. The number of patients admitted to pulmonology/critical care appeared stable (Figure 1A). Patients admitted to cardiology were more likely to be younger (Figure 1B) and had less risk factors for acute PE, such as cancer and recent surgery. The PE severity indices were higher in patients admitted to cardiology with a higher prevalence of tachycardia, syncope, signs of right ventricular dysfunction and shock (Table 1). There was an overall trend towards decrease in systemic thrombolysis and increase in catheter-directed thrombolysis independent of the admitting department. Catheter-directed thrombectomy has increased when patients were admitted to cardiology and internal medicine, but not when patients were admitted to pulmonology/critical care. Trends for in-hospital mortality were decreasing linearly over time independent of the admitting clinical service. In the multivariable adjustment, admission to cardiology was associated with significantly reduced rates of in-hospital mortality (OR 0.73, 95% CI 0.71-0.74).

Conclusion
In this nationwide analysis, the majority of patients with PE were hospitalized in an internal medicine ward, while notably, cardiology admissions demonstrated unique patient characteristics compared to other departments and were associated with decreased in-hospital mortality, suggesting specialized care's potential benefits in PE management.Table 1Figure 1