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Thromb Haemost 2018; 118(03): 539-546
DOI: 10.1160/TH17-08-0531
Stroke, Systemic or Venous Thromboembolism
Schattauer GmbH Stuttgart

Acute Pulmonary Embolism in a National Danish Cohort: Increasing Incidence and Decreasing Mortality

Per Lehnert
,
Theis Lange
,
Christian Holdflod Møller
,
Peter Skov Olsen
,
Jørn Carlsen
 Funding The study has not received any grants or external funding.
Further Information

Publication History

01 August 2017

01 December 2017

Publication Date:
01 February 2018 (online)

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Abstract

This study reports the incidence, clinical profile and mortality for acute pulmonary embolism (PE) patients in the Danish population in four eras from 2004 to 2014. Patients admitted with first-time acute PE from 2004 through 2014 were identified from national patient registries classified according to the International Classification of Diseases, 10th edition, World Health Organization. A total of 30,275 patients from a population of 4,301,673 adult residents aged 18 years or older were diagnosed with first-time acute PE, corresponding to an incidence of 64 (95% confidence interval: 61–66) per 100,000 adult residents per year. Throughout the study period, PE incidence increased from 45 to 83 per 100,000 adult residents. Age at disease onset also increased during the study period, rising from 67.1 to 68.0 (p = 0.002). Cancer was the most frequent concomitant diagnosis, with an incidence of 15.9%. Thoracic computed tomography and referral to specialized cardiac centres increased significantly throughout the study period. The 30- and 90-day mortality rates decreased between 2004 and 2014 from 17 to 11% and from 23 to 18% (p < 0.00), respectively. The 5-year mortality risk was reduced when comparing Era IV (2012–2014) with Era I (2004–2005), with a hazard ratio of 0.93 (p = 0.01). In Denmark, the annual incidence of acute PE has increased during the past decade from 45 to 83 per 100,000 adults with a significant decrease in both short- and long-term mortalities. In recent years, patients were more likely to be investigated with modern diagnostics and referred to cardiac centres for specialized treatment.

Keywords

acute pulmonary embolism - incidence - mortality - national cohort
 

  • References

  • 1 Spencer FA, Emery C, Lessard D. , et al. The Worcester Venous Thromboembolism study: a population-based study of the clinical epidemiology of venous thromboembolism. J Gen Intern Med 2006; 21 (07) 722-727
    CrossrefPubMedSearch in Google Scholar
  • 2 Silverstein MD, Heit JA, Mohr DN, Petterson TM, O'Fallon WM, Melton III LJ. Trends in the incidence of deep vein thrombosis and pulmonary embolism: a 25-year population-based study. Arch Intern Med 1998; 158 (06) 585-593
    CrossrefPubMedSearch in Google Scholar
  • 3 Tagalakis V, Patenaude V, Kahn SR, Suissa S. Incidence of and mortality from venous thromboembolism in a real-world population: the Q-VTE Study Cohort. Am J Med 2013; 126 (09) 832.e13-832.e21
    PubMedSearch in Google Scholar
  • 4 Cushman M, Tsai AW, White RH. , et al. Deep vein thrombosis and pulmonary embolism in two cohorts: the longitudinal investigation of thromboembolism etiology. Am J Med 2004; 117 (01) 19-25
    CrossrefPubMedSearch in Google Scholar
  • 5 Nordström M, Lindblad B. Autopsy-verified venous thromboembolism within a defined urban population–the city of Malmö, Sweden. APMIS 1998; 106 (03) 378-384
    CrossrefPubMedSearch in Google Scholar
  • 6 Kucher N, Rossi E, De Rosa M, Goldhaber SZ. Massive pulmonary embolism. Circulation 2006; 113 (04) 577-582
    CrossrefPubMedSearch in Google Scholar
  • 7 Torbicki A, Perrier A, Konstantinides S. , et al; ESC Committee for Practice Guidelines (CPG). Guidelines on the diagnosis and management of acute pulmonary embolism: the Task Force for the Diagnosis and Management of Acute Pulmonary Embolism of the European Society of Cardiology (ESC). Eur Heart J 2008; 29 (18) 2276-2315
    CrossrefPubMedSearch in Google Scholar
  • 8 Heit JA, Silverstein MD, Mohr DN, Petterson TM, O'Fallon WM, Melton III LJ. Predictors of survival after deep vein thrombosis and pulmonary embolism: a population-based, cohort study. Arch Intern Med 1999; 159 (05) 445-453
    CrossrefPubMedSearch in Google Scholar
  • 9 Heit JA, Spencer FA, White RH. The epidemiology of venous thromboembolism. J Thromb Thrombolysis 2016; 41 (01) 3-14
    CrossrefPubMedSearch in Google Scholar
  • 10 Hess S, Frary EC, Gerke O, Madsen PH. State-of-the-art imaging in pulmonary embolism: ventilation/perfusion single-photon emission computed tomography versus computed tomography angiography - controversies, results, and recommendations from a systematic review. Semin Thromb Hemost 2016; 42 (08) 833-845
    Thieme ConnectPubMedSearch in Google Scholar
  • 11 Gutte H, Mortensen J, Jensen CV. , et al. Comparison of V/Q SPECT and planar V/Q lung scintigraphy in diagnosing acute pulmonary embolism. Nucl Med Commun 2010; 31 (01) 82-86
    CrossrefPubMedSearch in Google Scholar
  • 12 Løkkegaard E, Lidegaard O, Møller LN, Agger C, Andreasen AH, Jørgensen T. Hormone replacement therapy in Denmark, 1995-2004. Acta Obstet Gynecol Scand 2007; 86 (11) 1342-1351
    CrossrefPubMedSearch in Google Scholar
  • 13 Søndergaard Milter MC. Surviving Cancer in Denmark 2000–2014 - The National Board of Health Data. 2016 . Available at: http://sundhedsdatastyrelsen.dk/da/tal-og-analyser/analyser-og-rapporter/sygdomme/kraeftoverlevelse . Accessed May 2016
    PubMedSearch in Google Scholar
  • 14 Huang W, Goldberg RJ, Anderson FA, Kiefe CI, Spencer FA. Secular trends in occurrence of acute venous thromboembolism: the Worcester VTE study (1985-2009). Am J Med 2014; 127 (09) 829-39.e5
    CrossrefPubMedSearch in Google Scholar
  • 15 Oger E. ; EPI-GETBP Study Group. Incidence of venous thromboembolism: a community-based study in Western France. EPI-GETBP Study Group. Groupe d'Etude de la Thrombose de Bretagne Occidentale. Thromb Haemost 2000; 83 (05) 657-660
    Thieme ConnectPubMedSearch in Google Scholar
  • 16 Delluc A, Tromeur C, Le Ven F. , et al; EPIGETBO study group. Current incidence of venous thromboembolism and comparison with 1998: a community-based study in Western France. Thromb Haemost 2016; 116 (05) 967-974
    Thieme ConnectPubMedSearch in Google Scholar
  • 17 Cohen AT, Agnelli G, Anderson FA. , et al; VTE Impact Assessment Group in Europe (VITAE). Venous thromboembolism (VTE) in Europe. The number of VTE events and associated morbidity and mortality. Thromb Haemost 2007; 98 (04) 756-764
    Thieme ConnectPubMedSearch in Google Scholar
  • 18 Heit JA, Silverstein MD, Mohr DN, Petterson TM, O'Fallon WM, Melton III LJ. Risk factors for deep vein thrombosis and pulmonary embolism: a population-based case-control study. Arch Intern Med 2000; 160 (06) 809-815
    CrossrefPubMedSearch in Google Scholar
  • 19 Hettiarachchi RJ, Lok J, Prins MH, Büller HR, Prandoni P. Undiagnosed malignancy in patients with deep vein thrombosis: incidence, risk indicators, and diagnosis. Cancer 1998; 83 (01) 180-185
    CrossrefPubMedSearch in Google Scholar
  • 20 Dalen JE. Pulmonary embolism: what have we learned since Virchow? Natural history, pathophysiology, and diagnosis. Chest 2002; 122 (04) 1440-1456
    CrossrefPubMedSearch in Google Scholar
  • 21 Kearon C. Natural history of venous thromboembolism. Circulation 2003; 107 (23) (Suppl. 01) I22-I30
    CrossrefPubMedSearch in Google Scholar
  • 22 Aleva FE, Voets LWLM, Simons SO, de Mast Q, van der Ven AJAM, Heijdra YF. Prevalence and localization of pulmonary embolism in unexplained acute exacerbations of COPD: a systematic review and meta-analysis. Chest 2017; 151 (03) 544-554
    CrossrefPubMedSearch in Google Scholar
  • 23 Guler GB, Can MM, Guler E. , et al. Asymptomatic pulmonary embolism after ablation. Cardiology 2016; 134 (04) 426-432
    CrossrefPubMedSearch in Google Scholar
  • 24 Anderson Jr FA, Spencer FA. Risk factors for venous thromboembolism. Circulation 2003; 107 (23) (Suppl. 01) I9-I16
    CrossrefPubMedSearch in Google Scholar
  • 25 Goldhaber SZ, Visani L, De Rosa M. Acute pulmonary embolism: clinical outcomes in the International Cooperative Pulmonary Embolism Registry (ICOPER). Lancet 1999; 353 (9162): 1386-1389
    CrossrefPubMedSearch in Google Scholar
  • 26 Konstantinides SV, Torbicki A, Agnelli G. , et al; Task Force for the Diagnosis and Management of Acute Pulmonary Embolism of the European Society of Cardiology (ESC). 2014 ESC guidelines on the diagnosis and management of acute pulmonary embolism. Eur Heart J 2014; 35 (43) 3033-3069 , 3069a–3069k
    CrossrefPubMedSearch in Google Scholar
  • 27 Naess IA, Christiansen SC, Romundstad P, Cannegieter SC, Rosendaal FR, Hammerstrøm J. Incidence and mortality of venous thrombosis: a population-based study. J Thromb Haemost 2007; 5 (04) 692-699
    CrossrefPubMedSearch in Google Scholar
  • 28 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
  • 29 Meneveau N, Ming LP, Séronde MF. , et al. In-hospital and long-term outcome after sub-massive and massive pulmonary embolism submitted to thrombolytic therapy. Eur Heart J 2003; 24 (15) 1447-1454
    CrossrefPubMedSearch in Google Scholar
  • 30 Lehnert P, Møller CH, Mortensen J, Kjaergaard J, Olsen PS, Carlsen J. Surgical embolectomy compared to thrombolysis in acute pulmonary embolism: morbidity and mortality. Eur J Cardiothorac Surg 2017; 51 (02) 354-361
    PubMedSearch in Google Scholar
  • 31 Severinsen MT, Kristensen SR, Overvad K, Dethlefsen C, Tjønneland A, Johnsen SP. Venous thromboembolism discharge diagnoses in the Danish National Patient Registry should be used with caution. J Clin Epidemiol 2010; 63 (02) 223-228
    CrossrefPubMedSearch in Google Scholar
  • 32 Sundbøll J, Adelborg K, Munch T. , et al. Positive predictive value of cardiovascular diagnoses in the Danish National Patient Registry: a validation study. BMJ Open 2016; 6 (11) e012832
    CrossrefPubMedSearch in Google Scholar