Pulmonary Embolism Mortality Associated with the Necessity of Being Hospitalized Outside the Canton of Residence in Ecuador

Abstract

Introduction: Pulmonary embolism (PE) is a common cause of cardiovascular death, with hospital mortality rates in South America around 14%. However, there is limited information regarding Ecuador. Objectives: To present a survival analysis of Ecuadorian patients affected by PE. Methods: We performed a survival analysis study based on the retrospective review of the hospital discharges by PE in Ecuador from 2011 to 2018 through the Ecuadorian National Statistics and Census Institute databases. Results: We found 2974 cases of PE. From them, 505 (16.98%) patients deceased, 59.72% were females, 64.79% had an age ≥60 years with an average of 65.04 years, 19.80% were treated outside their canton of residence, and 7.57% were associated to acute cor pulmonale (ACP). Using the Cox regression model, being treated outside the canton of residence (HR 1.40, p<0.05) and age ≥60 years (HR 1.64, p<0.05) reduced the overall survival. Contrasting, the absence of ACP improved the OS (HR 0.68, p<0.05). Excluding patients aged ≥60 years, and with ACP, being treated outside the canton of residence increased the risk of death by PE (HR 1.77, p<0.05). However, this effect was non significative in patients ≥60 years of age and with ACP (p>0.05). Conclusion: Patients treated by PE outside their canton of residence had an increased risk of mortality during the in-hospital stay, especially those younger than 60 years without ACP.