Pulmonary Embolism-Attributable Mortality in Patients With Heart Failure in the United States, 2010 to 2020

Contemporary trends in pulmonary embolism (PE)-attributable mortality among U.S. patients with heart failure (HF) remain underexplored.

The objective of the study was to evaluate trends in PE-attributable mortality from 2010 to 2020 among US patients with HF, stratified by age, sex, race/ethnicity, urbanicity, and region.

Data on PE-attributable mortality in HF patients aged ≥25 years were obtained from the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research database from January 2010 to December 2020. Age-adjusted mortality rates (AAMRs) were analyzed using joinpoint regression to calculate average annual percentage change with 95% CIs. Concurrent trends in HF prevalence and venous thromboembolism risk factors were assessed using the National Health and Nutrition Examination Survey data set.

Between 2010 and 2020, 38,129 U.S. patients with HF aged ≥25 years (17,772 men and 20,357 women) died from PE, corresponding to a proportionate mortality of 97.5 per 1,000 deaths (≈9.8%). AAMR linearly increased during this period (average annual percentage change: +4.7%; 95% CI: 3.3%-6.1%; P < 0.001), with no sex differences (P for parallelism = 0.23). The AAMR increased among individuals aged 25 to 65 years, Asian/Pacific Islanders, non-Hispanic/non-Latinx Black individuals, and residents of the Midwest. Although age-adjusted prevalence of HF plateaued overall, HF patients aged with concomitant rises in age-adjusted rates of obesity, prior smoking, atherosclerotic cardiovascular disease, chronic kidney disease, and cancer (P < 0.001 for all).

PE-attributable mortality among U.S. patients with HF has risen significantly over the past decade particularly among younger adults, certain ethnoracial groups, and residents of the Midwest.