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CC BY-NC-ND 4.0 · Thromb Haemost 2025; 125(04): 364-375
DOI: 10.1055/a-2402-6192
Stroke, Systemic or Venous Thromboembolism

Time Trends and Excess Mortality Compared to Population Controls after a First-Time Pulmonary Embolism or Deep Vein Thrombosis

Katarina Glise Sandblad 
1   Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
2   Department of Medicine, Geriatrics and Emergency Medicine, Region Västra Götaland, Sahlgrenska University Hospital/Östra, Gothenburg, Sweden
,
Carl Johan Svensson
3   Department of Anaesthesiology and Intensive Care, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
4   Department of Anaesthesiology and Intensive Care, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
,
Kristina Svennerholm
3   Department of Anaesthesiology and Intensive Care, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
4   Department of Anaesthesiology and Intensive Care, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
,
Jacob Philipson
1   Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
2   Department of Medicine, Geriatrics and Emergency Medicine, Region Västra Götaland, Sahlgrenska University Hospital/Östra, Gothenburg, Sweden
,
Aldina Pivodic
5   APNC Sweden, Gothenburg, Sweden
,
Sam Schulman 
6   Department of Medicine and Thrombosis and Atherosclerosis Research Institute, McMaster University, Hamilton, Ontario, Canada
,
Mazdak Tavoly
7   Department of Medicine, Geriatrics and Emergency Medicine, Region Västra Götaland, Sahlgrenska University Hospital/Sahlgrenska, Gothenburg, Sweden
8   Department of Research, Østfold Hospital, Sarpsborg, Norway
› Author Affiliations Funding This study was supported by the Swedish Heart and Lung Foundation (2022–0216); the Swedish state under the agreement between the Swedish government and the county councils (ALFGBG-965023); the Gothenburg Society of Medicine (GLS-986108); Elsa and Gustav Lindh's Foundation, Sahlgrenska University Hospital Research Foundations (SU-984390), and Emelle Funds. The funding sources were not involved in study design; in the collection, analysis, or interpretation of data; in the writing of the report; or in the decision to submit the article for publication.
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Abstract

Background

Recent data on temporal trends in excess mortality for patients with pulmonary embolism (PE) and deep vein thrombosis (DVT) compared with the general population are scarce.

Methods

A nationwide Swedish register study conducted from 2006 to 2018 including 68,960 PE and 70,949 DVT cases matched with population controls. Poisson regression determined relative risk (RR) for 30-day and 1-year mortality trends while Cox regression determined adjusted hazard ratios (aHRs). A significance level of 0.001 was applied.

Results

In PE cases, both 30-day mortality (12.5% in 2006 to 7.8% in 2018, RR: 0.95 [95% CI: 0.95–0.96], p < 0.0001) and 1-year mortality (26.5 to 22.1%, RR: 0.98 [0.97–0.98], p < 0.0001) decreased during the study period. Compared with controls, no significant change was seen in 30-day (aHR: 33.08 [95% CI: 25.12–43.55] to 24.64 [95% CI: 18.81–32.27], p = 0.0015 for interaction with calendar year) or 1-year (aHR: 5.85 [95% CI: 5.31–6.45] to 7.07 [95% CI: 6.43–7.78], p = 0.038) excess mortality. The 30-day excess mortality decreased significantly (aHR: 39.93 [95% CI: 28.47–56.00) to 24.63 [95% CI: 17.94–33.83], p = 0.0009) in patients with PE without known cancer before baseline, while the excess 1-year mortality increased (aHR: 3.55 [95% CI: 3.16–3.99] to 5.38 [95% CI: 4.85–5.98], p < 0.0001) in PE cases surviving to fill a prescription of anticoagulation. In DVT cases, 30-day and 1-year mortality declined, while excess mortality compared with controls remained stable.

Conclusion

In general, the improved mortality following PE and DVT paralleled population trends. However, PE cases without cancer had decreasing excess 30-day mortality, whereas those surviving to fill a prescription for anticoagulant medication showed increasing excess 1-year mortality.

Keywords

deep vein thrombosis - pulmonary embolism - mortality - trends

Data Availability Statement

The data that support the findings of this study are available from The National Board of Health and Welfare and Statistics, Sweden, but restrictions apply to the availability of these data, so they are not publicly available.


Authors' Contribution

K.G.S. planned the study. All authors, particularly M.T. and K.G.S., made important contributions to the design of this study. A.P. preformed statistical analyses. All authors were involved in interpreting the data. K.G.S. wrote the first draft of the manuscript. K.G.S., M.T., J.P., S.S., K.S., and C.J.S. provided clinical input at all stages of the project. All authors, particularly M.T. and K.G.S., reviewed and edited the manuscript. All authors approved the final draft.


Supplementary Material



Publication History

Received: 20 June 2024

Accepted: 20 August 2024

Accepted Manuscript online:
23 August 2024

Article published online:
12 September 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Georg Thieme Verlag KG
Stuttgart · New York

Comment to this article:

Are More Patients with Thromboembolic Disease Dying Now Than Before?Thromb Haemost 2025; 125(04): 376-378
DOI: 10.1055/a-2436-4669

 

  • References

  • 1 Konstantinides SV, Meyer G, Becattini C. et al; The Task Force for the diagnosis and management of acute pulmonary embolism of the European Society of Cardiology (ESC). 2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS): the Task Force for the diagnosis and management of acute pulmonary embolism of the European Society of Cardiology (ESC). Eur Respir J 2019; 54 (03) 2019
    CrossrefPubMedSearch in Google Scholar
  • 2 Kearon C, Akl EA, Ornelas J. et al. Antithrombotic therapy for VTE disease: CHEST guideline and expert panel report. Chest 2016; 149 (02) 315-352
    CrossrefPubMedSearch in Google Scholar
  • 3 Stevens SM, Woller SC, Kreuziger LB. et al. Antithrombotic therapy for VTE disease: second update of the CHEST guideline and expert panel report. Chest 2021; 160 (06) e545-e608
    CrossrefPubMedSearch in Google Scholar
  • 4 Hunt BJ. Preventing hospital associated venous thromboembolism. BMJ 2019; 365: l4239
    CrossrefPubMedSearch in Google Scholar
  • 5 Barco S, Mahmoudpour SH, Valerio L. et al. Trends in mortality related to pulmonary embolism in the European region, 2000-15: analysis of vital registration data from the WHO Mortality Database. Lancet Respir Med 2020; 8 (03) 277-287
    CrossrefPubMedSearch in Google Scholar
  • 6 Barco S, Valerio L, Ageno W. et al. Age-sex specific pulmonary embolism-related mortality in the USA and Canada, 2000-18: an analysis of the WHO Mortality Database and of the CDC Multiple Cause of Death database. Lancet Respir Med 2021; 9 (01) 33-42
    CrossrefPubMedSearch in Google Scholar
  • 7 Martin KA, Molsberry R, Cuttica MJ, Desai KR, Schimmel DR, Khan SS. Time trends in pulmonary embolism mortality rates in the United States, 1999 to 2018. J Am Heart Assoc 2020; 9 (17) e016784
    CrossrefPubMedSearch in Google Scholar
  • 8 Zuin M, Bikdeli B, Armero A. et al. Trends in Pulmonary embolism deaths among young adults aged 25 to 44 years in the United States, 1999 to 2019. Am J Cardiol 2023; 202: 169-175
    CrossrefPubMedSearch in Google Scholar
  • 9 Olié V, Fuhrman C, Chin F, Lamarche-Vadel A, Scarabin PY, de Peretti C. Time trends in pulmonary embolism mortality in France, 2000-2010. Thromb Res 2015; 135 (02) 334-338
    CrossrefPubMedSearch in Google Scholar
  • 10 Schuppener LM, Olson K, Brooks EG. Death certification: errors and interventions. Clin Med Res 2020; 18 (01) 21-26
    CrossrefPubMedSearch in Google Scholar
  • 11 Kraaijpoel N, Tritschler T, Guillo E, Girard P, Le Gal G. Definitions, adjudication, and reporting of pulmonary embolism-related death in clinical studies: a systematic review. J Thromb Haemost 2019; 17 (10) 1590-1607
    CrossrefPubMedSearch in Google Scholar
  • 12 Madsen SF, Christensen DM, Strange JE. et al. Short- and long-term mortality for patients with and without a cancer diagnosis following pulmonary embolism in denmark, 2000 to 2020: a nationwide study. J Am Heart Assoc 2023; 12 (23) e030191
    CrossrefPubMedSearch in Google Scholar
  • 13 Lehnert P, Lange T, Møller CH, Olsen PS, Carlsen J. Acute pulmonary embolism in a national Danish cohort: increasing incidence and decreasing mortality. Thromb Haemost 2018; 118 (03) 539-546
    Thieme ConnectPubMedSearch in Google Scholar
  • 14 Jiménez D, de Miguel-Díez J, Guijarro R. et al; RIETE Investigators. Trends in the management and outcomes of acute pulmonary embolism: analysis from the RIETE registry. J Am Coll Cardiol 2016; 67 (02) 162-170
    CrossrefPubMedSearch in Google Scholar
  • 15 CDR(0 year), All causes, per 100 000. 2023. World Health Organization. (2024, May). Trends in cause-specific mortality by sex for a selected country or area and age-group. Available at: https://platform.who.int/mortality/themes/theme-details/MDB/all-causes
    PubMed
  • 16 Søgaard KK, Schmidt M, Pedersen L, Horváth-Puhó E, Sørensen HT. 30-year mortality after venous thromboembolism: a population-based cohort study. Circulation 2014; 130 (10) 829-836
    CrossrefPubMedSearch in Google Scholar
  • 17 Weitz JI, Haas S, Ageno W. et al; GARFIELD-VTE investigators. Cancer associated thrombosis in everyday practice: perspectives from GARFIELD-VTE. J Thromb Thrombolysis 2020; 50 (02) 267-277
    CrossrefPubMedSearch in Google Scholar
  • 18 Ludvigsson JF, Andersson E, Ekbom A. et al. External review and validation of the Swedish national inpatient register. BMC Public Health 2011; 11: 450
    CrossrefPubMedSearch in Google Scholar
  • 19 Statistical register's production and quality National Patient Register. The National Board of Health and Welfare. 2024 . Accessed January 18, 2024 at: https://www.socialstyrelsen.se/globalassets/sharepoint-dokument/dokument-webb/statistik/production-and-quality-of-the-patient-register.pdf
    PubMedSearch in Google Scholar
  • 20 Wettermark B, Hammar N, Fored CM. et al. The new Swedish Prescribed Drug Register–opportunities for pharmacoepidemiological research and experience from the first six months. Pharmacoepidemiol Drug Saf 2007; 16 (07) 726-735
    CrossrefPubMedSearch in Google Scholar
  • 21 Brooke HL, Talbäck M, Hörnblad J. et al. The Swedish cause of death register. Eur J Epidemiol 2017; 32 (09) 765-773
    CrossrefPubMedSearch in Google Scholar
  • 22 Ludvigsson JF, Almqvist C, Bonamy AK. et al. Registers of the Swedish total population and their use in medical research. Eur J Epidemiol 2016; 31 (02) 125-136
    CrossrefPubMedSearch in Google Scholar
  • 23 Population Statistics. Statistics Sweden. 2024 . Available at: https://www.scb.se/en/finding-statistics/statistics-by-subject-area/population/population-composition/population-statistics/
    PubMedSearch in Google Scholar
  • 24 Öhman L, Johansson M, Jansson JH, Lind M, Johansson L. Positive predictive value and misclassification of diagnosis of pulmonary embolism and deep vein thrombosis in Swedish patient registries. Clin Epidemiol 2018; 10: 1215-1221
    CrossrefPubMedSearch in Google Scholar
  • 25 Abdul Sultan A, West J, Stephansson O. et al. Defining venous thromboembolism and measuring its incidence using Swedish health registries: a nationwide pregnancy cohort study. BMJ Open 2015; 5 (11) e008864
    CrossrefPubMedSearch in Google Scholar
  • 26 Fang MC, Fan D, Sung SH. et al. Treatment and outcomes of acute pulmonary embolism and deep venous thrombosis: the CVRN VTE study. Am J Med 2019; 132 (12) 1450-1457.e1
    CrossrefPubMedSearch in Google Scholar
  • 27 Wiener RS, Schwartz LM, Woloshin S. Time trends in pulmonary embolism in the United States: evidence of overdiagnosis. Arch Intern Med 2011; 171 (09) 831-837
    CrossrefPubMedSearch in Google Scholar
  • 28 Thrane PG, Olesen KKW, Thim T. et al. Mortality trends after primary percutaneous coronary intervention for ST-segment elevation myocardial infarction. J Am Coll Cardiol 2023; 82 (10) 999-1010
    CrossrefPubMedSearch in Google Scholar
  • 29 Eckelt J, Hobohm L, Merten MC. et al. Long-term mortality in patients with pulmonary embolism: results in a single-center registry. Res Pract Thromb Haemost 2023; 7 (05) 100280
    CrossrefPubMedSearch in Google Scholar
  • 30 van Walraven C, Austin P. Administrative database research has unique characteristics that can risk biased results. J Clin Epidemiol 2012; 65 (02) 126-131
    CrossrefPubMedSearch in Google Scholar