Clinical outcomes and disparities in advanced therapy use among elderly patients with pulmonary embolism complicated with cardiogenic shock: a nationwide analysis

Background

Pulmonary embolism (PE) complicated by cardiogenic shock (CS) is associated with significant morbidity and mortality. As the population ages, understanding age-related differences in outcomes and management is critical to optimizing care in this high-risk cohort.

Methods

Using the National Inpatient Sample database, adults hospitalized with PE and CS, stratifying them into elderly (≥80 years) and younger (18–79 years) groups in the U.S. between 2016-2022. Multivariable logistic regression was performed to evaluate age-based differences in in-hospital outcomes and utilization of advanced therapies.

Results

Among 55,420 patients with PE and CS, 7,780 (14%) were elderly. In-hospital mortality was significantly higher in elderly patients compared with younger patients (47% vs 37%; adjusted odds ratio [aOR] 1.51, 95% CI 1.43–1.60; p<0.0001).

Despite higher mortality, elderly patients were less likely to receive advanced interventions, including mechanical ventilation (30% vs 43%; aOR 0.68, 95% CI 0.64–0.72), extracorporeal membrane oxygenation ECMO (0.2% vs 6%; aOR 0.06, 95% CI 0.04–0.09), Impella support (1% vs 3%; aOR 0.44, 95% CI 0.35–0.56), and intra-aortic balloon pump IABP (3% vs 5%; aOR 0.54, 95% CI 0.46–0.63) (all p<0.0001).

Elderly patients also had higher odds of heart block (15% vs. 10%; aOR 1.49; 95% CI: 1.37 - 1.61), permanent pacemaker implantation (2% vs. 1%; aOR 2.28; 95% CI: 1.80 - 2.90) and in-hospital myocardial infarction (29% vs. 23%; aOR 1.32; 95% CI: 1.25 - 1.41); all p<0.0001.

Conclusion

Elderly patients with PE complicated by CS experience significantly higher in-hospital mortality while receiving fewer advanced mechanical and circulatory support therapies. These findings suggest potential management disparities and underscore the importance of individualized, age-conscious decision-making that balances clinical risk, frailty, and patient preferences to improve outcomes in this vulnerable population.Central IllustrationBar Graph