Regional Variations in the Management and Outcomes of Pulmonary Embolism: A Five-Year United States Analysis

Acute pulmonary embolism (PE) is one of the most common causes of cardiovascular mortality in the United States. Significant variations in the management of various cardiovascular conditions have previously been reported, but this has been poorly elucidated for pulmonary embolism.

During 2016-2020, adult (≥ 18 years) nonelective admissions with PE, admitted to Northeast, Midwest, South, and West geographic regions were identified using the National Inpatient Sample. Outcomes of interest included in-hospital mortality, utilization of PE therapies, non-cardiac organ support, total hospitalization costs, and hospitalization duration.

In this 5-year duration, 904,260 admissions were identified - Northeast, Midwest, South, and West had 166,050 (18.3%), 225,680 (24.9%), 350,160 (38.7%), and 162,370 (17.9%) admissions, respectively. On average, admissions to the Northeast were less comorbid, from a higher socioeconomic status, privately insured, and more commonly admitted to urban teaching and medium-sized hospitals (all p < 0.001). The Northeast region also had the lowest rates of definitive PE therapies except surgical thrombectomy. In comparison to the Northeast, the in-hospital mortality was higher in the South and West and lower in the Midwest region (3.1% vs 2.8% vs 3.2% vs 3.3%, p < 0.001). However, on adjusted analysis with Northeast as a reference, in-hospital mortality was noted to be lower in the Midwest (adjusted odds ratio [aOR] 0.98, 95% confidence interval [CI] 0.67-0.84; p < 0.001), South (aOR 0.89, 95% CI 0.80-0.98; p < 0.05), and the West (aOR 0.88, 95% CI 0.78-0.99; p < 0.05).

In this study, we noted significant heterogeneity in the management and outcome of pulmonary embolism across various regions of the United States.