CLINICAL AND PARACLINICAL CHARACTERISTICS IN ELDERLY PATIENTS WITH ACUTE PULMONARY EMBOLISM

Abstract

Background: Pulmonary embolism (PE) is a major cardiovascular emergency with high mortality in elderly patients. Atypical presentations and the coexistence of multimorbidity and frailty may complicate risk stratification and inpatient outcomes.

Objectives: To describe characteristics, risk stratification, and frailty in elderly patients with acute PE.

Methods: This retrospective descriptive study included patients aged ≥60 years admitted to Thong Nhat Hospital and Cho Ray Hospital from January 2019 to July 2024. Acute PE was confirmed by contrast-enhanced chest CT/CT pulmonary angiography. Data on symptoms, ECG, echocardiography, laboratory tests, and CT clot location were collected. Risk was stratified using PESI/sPESI and the 2019 ESC model. Frailty was assessed using the Hospital Frailty Risk Score (HFRS).

Results: This study included 237 patients, with a median age of 74 years (IQR 68–81), and women accounted for 73%. Hypertension (65%) and diabetes (32.9%) were common comorbidities; bed rest > 3 days accounted for 19.4% of risk factors. Dyspnea (68.8%) and chest pain (38.4%) were the most frequent symptoms; impaired consciousness occurred in 16.5%, respiratory failure in 60.8%, and hypotension in 15.6%. Echocardiography showed pulmonary hypertension in 54.9%, right ventricular dilatation in 41.8%, and TAPSE <16 mm in 38.0%. Lower-extremity deep venous thrombosis was detected in 45.1% (proximal DVT 38.8%). Median D-dimer and NT-proBNP were 6466 ng/mL and 1226 pg/mL, respectively. Most patients were classified as PESI class III–V (80.2%); by the 2019 ESC model, intermediate risk predominated (76.8%) and high risk accounted for 14.8%. Frailty (HFRS ≥5) was present in 48.1%. Initial treatment mainly consisted of low-molecular-weight heparin (78.5%); thrombolytic reperfusion was performed in 14.3% of patients.

In-hospital complications included infection (27.0%), acute kidney injury (26.2%), ICU/CCU transfer (24.5%), bleeding (6.8%), and mortality (9.3%). In multivariable logistic regression, independent factors associated with in-hospital mortality were age ≥85 (p = 0.018), cancer (p = 0.014), COPD (p = 0.027), frailty by HFRS (p = 0.004), and systolic blood pressure <90 mmHg (p <0.001), obesity (p = 0.017). In the reduced Firth model, systolic blood pressure <90 mmHg (OR 8.0; 95% CI 2.930–21.775) and HFRS (OR 11.2; 95% CI 1.976–63.964) were identified as independent predictors.

Conclusions: Elderly patients with acute PE had substantial comorbidity burden and a high prevalence of frailty, with most classified as intermediate-to-high risk, with a substantial rate of in-hospital complications. Integrating frailty screening into risk stratification may support individualized management and comprehensive geriatric care to improve outcomes.

Keywords: pulmonary embolism; elderly patient; frailty; HFRS