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Semin Thromb Hemost 2023; 49(07): 725-735
DOI: 10.1055/s-0043-1764231
Review Article

Sex-Related Differences in Patient Characteristics, Risk Factors, and Symptomatology in Older Adults with Pulmonary Embolism: Findings from the SERIOUS-PE Study

Behnood Bikdeli
1   Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
2   Thrombosis Research Group, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
3   YNHH/Yale Center for Outcomes Research and Evaluation (CORE), New Haven, Connecticut
4   Cardiovascular Research Foundation (CRF), New York, New York
,
Alfonso Muriel
5   Department of Respiratory, Hospital Ramón y Cajal, Universidad de Alcalá (Instituto de Ramón y Cajal de Investigación Sanitaria), Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, Madrid, Spain
6   Clinical Biostatistics Unit, Hospital Universitario Ramón y Cajal, IRYCIS, CIBERESP: Universidad de Alcalá, Madrid, Spain
,
Yun Wang
3   YNHH/Yale Center for Outcomes Research and Evaluation (CORE), New Haven, Connecticut
7   Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
,
Gregory Piazza
1   Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
2   Thrombosis Research Group, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
,
Candrika D. Khairani
2   Thrombosis Research Group, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
,
Rachel P. Rosovsky
8   Division of Hematology/Oncology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
,
Ghazaleh Mehdipoor
4   Cardiovascular Research Foundation (CRF), New York, New York
9   Division of Nuclear Medicine, Department of Radiology, Montefiore Medical Center, Bronx, New York
,
Michelle L. O'Donoghue
1   Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
10   TIMI Study Group, Brigham and Women's Hospital, Boston, Massachusetts
,
Olga Madridano
11   Department of Internal Medicine, Hospital Universitario Infanta Sofía, Madrid, Spain
,
Juan Bosco Lopez-Saez
12   Department of Internal Medicine, Hospital Universitario de Puerto Real, Cádiz, Spain
,
Meritxell Mellado
13   Department of Angiology and Vascular Surgery, Hospital del Mar, Barcelona, Spain
,
Ana Maria Diaz Brasero
14   Department of Internal Medicine, Hospital Universitario de Guadalajara, Guadalajara, Spain
,
Elvira Grandone
15   Thrombosis and Haemostasis Unit, Fondazione I.R.C.C.S. “Casa Sollievo della Sofferenza,” Foggia, S. Giovanni Rotondo, Italy
16   Department of Medical and Surgical Sciences, Institute of Obstetrics and Gynecology, University of Foggia, Foggia, Italy
17   Department of Obstetrics Gynaecology and Perinatal Medicine, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
,
Primavera A. Spagnolo
18   Mary Horrigan Connors Center for Women's Health & Gender Biology, Harvard Medical School, Boston, Massachusetts
,
Yuan Lu
3   YNHH/Yale Center for Outcomes Research and Evaluation (CORE), New Haven, Connecticut
,
Laurent Bertoletti
19   Department of Psychiatry, Brigham and Women Hospital, Service de Médecine Vasculaire et Thérapeutique, CHU de St-Etienne, Saint-Etienne, France
20   INSERM, UMR1059, Equipe Dysfonction Vasculaire et Hémostase, Université Jean-Monnet, Saint-Etienne, France
21   INSERM, CIC-1408, CHU Saint-Etienne, Saint-Etienne, France
,
Luciano López-Jiménez
22   Department of Internal Medicine, Hospital Provincial Reina Sofía, Córdoba, Spain
,
Manuel Jesús Núñez
23   Department of Internal Medicine, Complejo Hospitalario de Pontevedra, Pontevedra, Spain
,
Ángeles Blanco-Molina
24   Department of Internal Medicine, Hospital Universitario Reina Sofía, Córdoba, Spain
,
Marie Gerhard-Herman
1   Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
,
Samuel Z. Goldhaber
1   Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
2   Thrombosis Research Group, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
,
Shannon M. Bates
25   Division of Hematology and Thromboembolism, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
,
David Jimenez
5   Department of Respiratory, Hospital Ramón y Cajal, Universidad de Alcalá (Instituto de Ramón y Cajal de Investigación Sanitaria), Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, Madrid, Spain
,
Harlan M. Krumholz
3   YNHH/Yale Center for Outcomes Research and Evaluation (CORE), New Haven, Connecticut
26   Department of Health Policy and Administration, Yale School of Public Health, New Haven, Connecticut
27   Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
,
Manuel Monreal
28   Chair for the Study of Thromboembolic Disease, Faculty of Health Sciences, UCAM - Universidad Católica San Antonio de Murcia, Murcia, Spain
,
The RIETE Investigators › Author Affiliations Funding B.B. is supported by the Scott Schoen and Nancy Adams IGNITE Award, as well as the Mary Ann Tynan Research Scientist Award, both from the Mary Horrigan Connors Center for Women's Health and Gender Biology at Brigham and Women's Hospital for the SERIOUS-PE study, and a Career Development Award from the American Heart Association and VIVA Physicians (#938814).
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Abstract

Sex-specific factors are implicated in pulmonary embolism (PE) presentation in young patients, as indicated by increased risk in pregnancy. Whether sex differences exist in PE presentation, comorbidities, and symptomatology in older adults, the age group in which most PEs occur, remains unknown. We identified older adults (aged ≥65 years) with PE in a large international PE registry replete with information about relevant clinical characteristics (RIETE registry, 2001–2021). To provide national data from the United States, we assessed sex differences in clinical characteristics and risk factors of Medicare beneficiaries with PE (2001–2019). The majority of older adults with PE in RIETE (19,294/33,462, 57.7%) and in the Medicare database (551,492/948,823, 58.7%) were women. Compared with men, women with PE less frequently had atherosclerotic diseases, lung disease, cancer, or unprovoked PE, but more frequently had varicose veins, depression, prolonged immobility, or history of hormonal therapy (p < 0.001 for all). Women less often presented with chest pain (37.3 vs. 40.6%) or hemoptysis (2.4 vs. 5.6%) but more often with dyspnea (84.6 vs. 80.9%) (p < 0.001 for all). Measures of clot burden, PE risk stratification, and use of imaging modalities were comparable between women and men. PE is more common in elderly women than in men. Cancer and cardiovascular disease are more common in men, whereas transient provoking factors including trauma, immobility, or hormone therapy are more common in elderly women with PE. Whether such differences correlate with disparities in treatment or differences in short- or long-term clinical outcomes warrants further investigation.

Keywords

sex - comorbidity - risk factory - pulmonary embolism - elderly - symptomatology

* A full list of the RIETE investigators is included in the [Supplementary Appendix A] (online only).


Supplementary Material



Publication History

Article published online:
03 March 2023

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