Long-term mortality in patients with first-time pulmonary embolism according to the presence of comorbidities at baseline: a nationwide register study.

Abstract

Pulmonary embolism (PE) is associated with high mortality and morbidity. However, data on the long-term mortality risk in cancer-free PE patients compared to the general population remains limited. To study long-term all-cause mortality (one year and longer) in cancer-free PE patients versus matched population controls, stratified by the presence or absence of comorbidities. To assess the impact of comorbidities on life expectancy and to identify predictors of long-term mortality. A nationwide Swedish register study including cancer-free patients diagnosed with a first-time PE from 2006 to 2023 and matched population controls. All-cause mortality was analyzed using Cox proportional hazard regression models, expressed as adjusted hazard ratios (aHRs). A total of 49,596 PE cases (mean age 67.3 years, 52.1% women) and 196,039 matched controls were included. One-year mortality was higher in PE cases (7.5%) compared to controls (1.6%). Among the PE cases, 53.6% had no comorbidities at baseline. Yet, the excess mortality risk remained elevated: one-year aHR 3.72 (95% CI, 3.36 - 4.12); beyond three years, aHR 1.54 (95% CI, 1.46 - 1.63). During follow-up, 18.5% of cases developed ischemic heart disease, and 22.7% heart failure. Cases without baseline comorbidities reached the 75th percentile of the survival distribution 8.1 years later (95% CI, 7.09-9.10) compared to PE patients with one or more comorbidities. Predictors of long-term mortality included heart failure (aHR 1.97, 95% CI, 1.88-2.06) and liver disease (aHR 2.17, 95% CI 1.88-2.51) CONCLUSION: PE increased long-term mortality risk even in the absence of baseline comorbidities. However, a substantial proportion of cases developed important conditions during follow-up, particularly cardiovascular diseases.