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2. Association Between Preexisting Versus Newly Identified Atrial Fibrillation and Outcomes of Patients With Acute Pulmonary Embolism

Author

Behnood Bikdeli, David Jiménez, Jorge del Toro, Gregory Piazza, Agustina Rivas, José Luis Fernández‐Reyes, Ángel Sampériz, Remedios Otero, José María Suriñach, Carmine Siniscalchi, Javier Miguel Martín‐Guerra, Joaquín Castro, Alfonso Muriel, Gregory Y. H. Lip, Samuel Z. Goldhaber, Manuel Monreal, Paolo Prandoni, Benjamin Brenner, Dominique Farge‐Bancel, Raquel Barba, Pierpaolo Di Micco, Laurent Bertoletti, Sebastian Schellong, Inna Tzoran, Abilio Reis, Marijan Bosevski, Henri Bounameaux, Radovan Malý, Peter Verhamme, Joseph A. Caprini, Hanh My Bui, María Dolores Adarraga, María Agud, Jesús Aibar, Miguel Ángel Aibar, Cristina Amado, Juan Ignacio Arcelus, Carlos Baeza, Aitor Ballaz, Cristina Barbagelata, Manuel Barrón, Belén Barrón‐Andrés, Ángeles Blanco‐Molina, Ernesto Botella, Ana María Camon, Inmaculada Cañas, Ignacio Casado, Leyre Chasco, Juan Criado, Cristina de Ancos, Javier de Miguel, Pablo Demelo‐Rodríguez, José Antonio Díaz‐Peromingo, Mario Virgilio Di Campli, Javier Díez‐Sierra, Irene Milagros Domínguez, José Carlos Escribano, Conxita Falgá, Ana Isabel Farfán‐Sedano, Carmen Fernández‐Capitán, Jose Luis Fernández‐Reyes, María Ángeles Fidalgo, Katia Flores, Carme Font, Llorenç Font, Iria Francisco, Cristina Gabara, Francisco Galeano‐Valle, David Galindo, María Angelina García, Ferrán García‐Bragado, Marta García de Herreros, Raquel García‐Hernáez, María Mar García‐Mullor, Arantxa García‐Raso, Olga Gavín‐Sebastián, Aida Gil‐Díaz, Covadonga Gómez‐Cuervo, Enric Grau, Leticia Guirado, Javier Gutiérrez, Luis Hernández‐Blasco, Elena Hernando, Miguel Herreros, Luis Jara‐Palomares, María Jesús Jaras, Rafael Jiménez, Maria Dolores Joya, José Manuel León, Jorge Lima, Pilar Llamas, José Luis Lobo, Luciano López‐Jiménez, Patricia López‐Miguel, Juan José López‐Núñez, Raquel López‐Reyes, Antonio López‐Ruiz, Juan Bosco López‐Sáez, Alicia Lorenzo, Olga Madridano, Ana Maestre, Pablo Javier Marchena, Mar Martín del Pozo, Francisco Martín‐Martos, Carmen Mella, Meritxell Mellado, Maria Isabel Mercado, Jorge Moisés, María del Valle Morales, Arturo Muñoz‐Blanco, Nuria Muñoz‐Rivas, María Sierra Navas, Jose Antonio Nieto, Manuel Jesús Núñez‐Fernández, Berta Obispo, Mónica Olid, María Carmen Olivares, José Luis Orcastegui, Clara Ortega‐Michel, Jeisson Osorio, Sonia Otalora, Pedro Parra, Virginia Parra, José María Pedrajas, Galadriel Pellejero, José Antonio Porras, José Portillo, Antoni Riera‐Mestre, Francisco Rivera‐Civico, Diego Agustín Rodríguez‐Chiaradía, Ana Rodríguez‐Cobo, Consolación Rodríguez‐Matute, Jacobo Rogado, Sonia Roig, Vladimir Rosa, Pedro Ruiz‐Artacho, Nuria Ruiz‐Giménez, Justo Ruiz‐Ruiz, Pablo Ruiz‐Sada, Giorgina Salgueiro, Rosario Sánchez‐Martínez, Juan Francisco Sánchez‐Muñoz‐Torrero, Teresa Sancho, Merçe Sirisi, Silvia Soler, Raimundo Tirado, María Isabel Torres, Carles Tolosa, Javier Trujillo‐Santos, Fernando Uresandi, Beatriz Valero, Reina Valle, Jerónimo Ramón Vela, Gemma Vidal, Paula Villares, Carles Zamora, Paula Gutiérrez, Fernando Javier Vázquez, Matthias Engelen, Thomas Vanassche, Jana Hirmerova, Estuardo Salgado, Nassim Ait Abdallah, Alessandra Bura‐Riviere, Benjamin Crichi, Philippe Debourdeau, Espitia Olivier, Nicolas Falvo, Silvia Galliazzo, Hélène Helfer, Isabelle Mahé, Farès Moustafa, Geraldine Poenou, Andrei Braester, Franca Bilora, Eugenio Bucherini, Maurizio Ciammaichella, Egidio Imbalzano, Rosa Maida, Daniela Mastroiacovo, Federica Pace, Raffaele Pesavento, Fulvio Pomero, Roberto Quintavalla, Anna Rocci, Roberta Romualdi, Antonella Tufano, Adriana Visonà, Beniamino Zalunardo, Valdis Gibietis, Dana Kigitovica, Andris Skride, Samuel Fonseca, Filipa Martins, Jose Meireles, Lucia Mazzolai, Alfonso J. Tafur, Cassius Iyad Ochoa‐Chaar, Ido Weinberg, Hannah Wilkins, Institut Català de la Salut, [Bikdeli B] Cardiovascular Medicine Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA. Yale/YNHH Center for Outcomes Research & Evaluation, New Haven, CT. Cardiovascular Research Foundation (CRF), New York, NY. [Jiménez D] Respiratory Department, Hospital Ramón y Cajal (IRYCIS), Madrid, Spain. Medicine Department, Universidad de Alcalá (IRYCIS), Madrid, Spain. CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Spain. [Del Toro J] Department of Internal Medicine, Hospital General Universitario Gregorio Marañón, Madrid, Spain. [Piazza G] Cardiovascular Medicine Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA. [Rivas A] Department of Pneumonology, Hospital Universitario Araba, Álava, Spain. [Fernández-Reyes JL] Department of Internal Medicine, Complejo Hospitalario de Jaén, Jaén, Spain. [Suriñach JM] Servei de Medicina Interna, Vall d’Hebron Hospital Universitari, Barcelona, Spain, Vall d'Hebron Barcelona Hospital Campus, Bikdeli, B., Jimenez, D., Toro, J. D., Piazza, G., Rivas, A., Fernandez-Reyes, J. L., Samperiz, A., Otero, R., Surinach, J. M., Siniscalchi, C., Martin-Guerra, J. M., Castro, J., Muriel, A., Lip, G. Y. H., Goldhaber, S. Z., Monreal, M., and Tufano, A

Subjects
Registrie, medicine.medical_specialty, Embolism, enfermedades cardiovasculares::enfermedades cardíacas::arritmias cardíacas::fibrilación atrial [ENFERMEDADES], Otros calificadores::/diagnóstico [Otros calificadores], Vascular Medicine, Risk Factors, Internal medicine, Other subheadings::Other subheadings::Other subheadings::/mortality [Other subheadings], Atrial Fibrillation, medicine, Other subheadings::/diagnosis [Other subheadings], Diseases of the circulatory (Cardiovascular) system, Humans, Registries, Cor - Malalties - Diagnòstic, Mortality, Original Research, Outcome, Otros calificadores::Otros calificadores::Otros calificadores::/mortalidad [Otros calificadores], business.industry, Risk Factor, Pulmonary embolism, Thrombosis, Atrial fibrillation, medicine.disease, Cardiovascular Diseases::Vascular Diseases::Embolism and Thrombosis::Embolism::Pulmonary Embolism [DISEASES], Stroke, Embòlia pulmonar - Mortalitat, RC666-701, Acute Disease, Cardiology, Avaluació de resultats (Assistència sanitària), Cardiology and Cardiovascular Medicine, business, enfermedades cardiovasculares::enfermedades vasculares::embolia y trombosis::embolia::embolia pulmonar [ENFERMEDADES], Cardiovascular Diseases::Heart Diseases::Arrhythmias, Cardiac::Atrial Fibrillation [DISEASES], Human
Abstract

Background Atrial fibrillation (AF) may exist before or occur early in the course of pulmonary embolism (PE). We determined the PE outcomes based on the presence and timing of AF. Methods and Results Using the data from a multicenter PE registry, we identified 3 groups: (1) those with preexisting AF, (2) patients with new AF within 2 days from acute PE (incident AF), and (3) patients without AF. We assessed the 90‐day and 1‐year risk of mortality and stroke in patients with AF, compared with those without AF (reference group). Among 16 497 patients with PE, 792 had preexisting AF. These patients had increased odds of 90‐day all‐cause (odds ratio [OR], 2.81; 95% CI, 2.33–3.38) and PE‐related mortality (OR, 2.38; 95% CI, 1.37–4.14) and increased 1‐year hazard for ischemic stroke (hazard ratio, 5.48; 95% CI, 3.10–9.69) compared with those without AF. After multivariable adjustment, preexisting AF was associated with significantly increased odds of all‐cause mortality (OR, 1.91; 95% CI, 1.57–2.32) but not PE‐related mortality (OR, 1.50; 95% CI, 0.85–2.66). Among 16 497 patients with PE, 445 developed new incident AF within 2 days of acute PE. Incident AF was associated with increased odds of 90‐day all‐cause (OR, 2.28; 95% CI, 1.75–2.97) and PE‐related (OR, 3.64; 95% CI, 2.01–6.59) mortality but not stroke. Findings were similar in multivariable analyses. Conclusions In patients with acute symptomatic PE, both preexisting AF and incident AF predict adverse clinical outcomes. The type of adverse outcomes may differ depending on the timing of AF onset.

Published
2021
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4. Patient-Level, Institutional, and Temporal Variations in Use of Imaging Modalities to Confirm Pulmonary Embolism

Author

Ghazaleh Mehdipoor, David Jimenez, Laurent Bertoletti, Ángeles Fidalgo, Juan Francisco Sanchez Muñoz-Torrero, José Pedro Gonzalez-Martinez, Ángeles Blanco-Molina, Miguel Ángel Aibar, Pierre-Benoît Bonnefoy, Ramin Khorasani, Martin R. Prince, Behnood Bikdeli, Manuel Monreal, María Dolores Adarraga, María Agud, Pedro Azcarate-Agüero, Jesús Aibar, Joaquín Alfonso, Cristina Amado, Juan Ignacio Arcelus, Aitor Ballaz, Raquel Barba, Cristina Barbagelata, Manuel Barrón, Belén Barrón-Andrés, Ana María Camon, Inmaculada Cañas, Juan Criado, Cristina de Ancos, Javier de Miguel, Jorge del Toro, Pablo Demelo-Rodríguez, Carmen Díaz-Pedroche, José Antonio Díaz-Peromingo, Raquel Díaz-Simón, Javier Díez-Sierra, Irene Milagros Domínguez, José Carlos Escribano, Ana Isabel Farfán, Carmen Fernández-Capitán, José Luis Fernández-Reyes, Katia Flores, Carme Font, Llorenç Font, Iria Francisco, Cristina Gabara, Francisco Galeano-Valle, María Ángeles García, Ferran García-Bragado, María García-García, Aránzazu García-Raso, Olga Gavín-Blanco, Olga Gavín-Sebastián, María Carmen Gayol, Aída Gil-Díaz, Covadonga Gómez-Cuervo, Enric Grau, Javier Gutiérrez-Guisado, Luis Hernández-Blasco, Marina Iglesias, Luis Jara-Palomares, María Jesús Jaras, María Dolores Joya, Inés Jou, Beatriz Lacruz, Antonio Lalueza, Ramón Lecumberri, Jorge Lima, Pilar Llamas, José Luis Lobo, Luciano López-Jiménez, Patricia López-Miguel, Juan José López-Núñez, Raquel López-Reyes, Juan Bosco López-Sáez, Manuel Alejandro Lorente, Alicia Lorenzo, Mónica Loring, Marina Lumbierres, Olga Madridano, Ana Maestre, Pablo Javier Marchena, Miguel Martín-Fernández, Javier Miguel Martín-Guerra, Francisco Martín-Martos, Meritxel Mellado, María Isabel Mercado, Jorge Moisés, María del Valle Morales, Arturo Muñoz-Blanco, Diego Muñoz-Guglielmetti, José Antonio Nieto, Manuel Jesús Núñez, María Carmen Olivares, Clara Ortega-Michel, María Dolores Ortega-Recio, Jeisson Osorio, Remedios Otero, Diana Paredes, Pedro Parra, Virginia Parra, José María Pedrajas, Galadriel Pellejero, Cristina Pérez-Ductor, María Asunción Pérez-Jacoíste, David Pesántez, José Antonio Porras, José Portillo, Lluis Reig, Antoni Riera-Mestre, Agustina Rivas, Ana Rodríguez-Cobo, Irene Rodríguez-Galán, Consolación Rodríguez-Matute, Vladimir Rosa, Carmen María Rubio, Pedro Ruiz-Artacho, Nuria Ruiz-Giménez, Justo Ruiz-Ruiz, Pablo Ruiz-Sada, Paloma Ruiz-Torregrosa, Joan Carles Sahuquillo, Giorgina Salgueiro, Ángel Sampériz, Teresa Sancho, Silvia Soler, Susana Suárez, José María Suriñach, Gregorio Tiberio, María Isabel Torres, Carlos Tolosa, Javier Trujillo-Santos, Fernando Uresandi, Esther Usandizaga, Reina Valle, Jeronimo Ramón Vela, Gemma Vidal, Paula Villares, Carles Zamora, Paula Gutiérrez, Fernando Javier Vázquez, Thomas Vanassche, Christophe Vandenbriele, Peter Verhamme, Jana Hirmerova, Radovan Malý, Estuardo Salgado, Ilham Benzidia, Alessandra Bura-Riviere, Benjamin Crichi, Philippe Debourdeau, Dominique Farge-Bancel, Hélène Helfer, Isabelle Mahé, Farès Moustafa, Geraldine Poenou, Sebastian Schellong, Andrei Braester, Benjamin Brenner, Inna Tzoran, María Amitrano, Franca Bilora, Cristiano Bortoluzzi, Barbara Brandolin, Eugenio Bucherini, Maurizio Ciammaichella, Donatella Colaizzo, Francesco Dentali, Pierpaolo Di Micco, Eliana Giammarino, Elvira Grandone, Fabio Maggi, Sara Mangiacapra, Daniela Mastroiacovo, Rosa Maida, Federica Pace, Raffaele Pesavento, Fulvio Pomero, Paolo Prandoni, Roberto Quintavalla, Anna Rocci, Carmine Siniscalchi, Eros Tiraferri, Antonella Tufano, Adriana Visonà, Ngoc Vo Hong, Beniamino Zalunardo, Roberts V. Kalejs, Dana Kigitovica, Andris Skride, Melanie Ferreira, Jose Meireles, Abilio Reis, Marijan Bosevski, Gorjan Krstevski, Marija Zdraveska, Henri Bounameaux, Lucia Mazzolai, Joseph A. Caprini, Alfonso J. Tafur, Ido Weinberg, Hannah Wilkins, and Hanh My Bui

Subjects
Diagnostic Imaging, Male, medicine.medical_specialty, pulmonary embolism, Hospitals, Low-Volume, Time Factors, Computed Tomography Angiography, Health Status, Perfusion Imaging, Comorbidity, Imaging modalities, Predictive Value of Tests, Pregnancy, medicine, Humans, Radiology, Nuclear Medicine and imaging, angiography, Prospective Studies, Registries, Healthcare Disparities, Practice Patterns, Physicians', thrombosis, Computed tomography angiography, Aged, Ultrasonography, Aged, 80 and over, Venous Thrombosis, Modality (human–computer interaction), medicine.diagnostic_test, business.industry, Ventilation/perfusion scan, Phlebography, Venous Thromboembolism, Middle Aged, medicine.disease, Thrombosis, Pulmonary embolism, Hospitalization, ventilation-perfusion scan, Angiography, Female, Radiology, Cardiology and Cardiovascular Medicine, business, Pulmonary Embolism, Hospitals, High-Volume, Magnetic Resonance Angiography
Abstract

Background: The choice of the imaging modality for diagnosis of pulmonary embolism (PE) could be influenced by provider, patient or hospital characteristics, or over time. However, little is known about the choice of the diagnostic modalities in practice. The aim of this study was to evaluate the variations in the use of imaging modalities for patients with acute PE. Methods: Using the data from Registro Informatizado Enfermedad TromboEmbolica (RIETE), a prospective international registry of patients with venous thromboembolism (March 2001–January 2019), we explored the imaging modalities used in patients with acute PE. The imaging modalities included computed tomography pulmonary angiography, ventilation/perfusion scanning, pulmonary angiography, a combination of these tests, or PE signs and symptoms plus imaging-confirmed proximal deep vein thrombosis but no chest imaging. Results: Among 38 025 patients with confirmed PE (53.1% female, age: 67.3±17 years), computed tomography pulmonary angiography was the dominant modality of diagnosis in all RIETE enrollees (78.2% [99% CI, 77.6–78.7]); including pregnant patients (58.9% [99% CI, 47.7%–69.4%]) and patients with severe renal insufficiency (62.5% [99% CI, 59.9–65.0]). A greater proportion of patients underwent ventilation/perfusion scanning in larger hospitals compared with smaller hospitals (13.1% versus 7.3%, P P Conclusions: In a large multinational PE registry, variations were observed in the use of imaging modalities according to patient or institutional factors and over time. However, computed tomography pulmonary angiography was the dominant modality of diagnosis, even in pregnancy and severe renal insufficiency. The safety, costs, and downstream effects of these tests on PE-related and non-PE-related outcomes warrant further investigation.

Published
2020

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