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Comparison of Pulmonary Embolism and Subsequent Cardiovascular Events Between Elderly and Young Patients in the Emergency Department (June, 2012)
ABSTRACT
 
Background:
Pulmonary embolism (PE) has been associated with the risk of arterial cardiovascular events, with diagnosis being difficult in older adults. Multiple factors contribute to mortality and morbidity in older adults. Hence, we aimed to investigate the difference of subsequent cardiovascular events (SCVE) and demography between younger and older adults.
 
Methods:
We undertook a retrospective cohort study using data from a 1100-bed urban medical center in Taipei, Taiwan. All patients who presented to the emergency department with a documented diagnosis of PE (ICD-9 of 415.19), from January 2003 to December 2008, were enrolled and specified into two age groups. Clinical follow-up was conducted until December 2009, with a median time of 3.5 years. The SCVE included new onset of ischemic stroke or heart attack and recurrence of PE. The time between when a patient was presented to the ER and when the diagnosis took place was assessed.
 
Results:
A total of 104 patients were studied, among which 58 patients were placed in the elderly group (≥ 65 years old) and 46 were placed in the young group (< 65 years old). There were significantly more females in the elderly group (n=43; 74.1%; p<0.05). Underlying morbidities including diabetes mellitus (DM), chronic renal failure, hypertension, ischemic stroke, ischemic heart disease, and heart failure were significantly more predominant in the elderly group. There was no significant difference between the two groups in terms of clinical presentation and the incidence of massive PE. A total of 9 patients (8.7%) expired during their hospital stay, with no difference between the two groups. SCVE showed only a significant difference among new ischemic heart disease (n=6; 10.3%). There was a significant difference in diagnosis intervals between the two groups (elderly=48.5±83.9hours; young=21.4±38.5 hours; < 0.05).
 
Conclusion:
Diagnosis intervals in the elderly were widely variable. Rapid and precise diagnosis of PE in the emergency department remains a challenge. Clinical presentations gave less useful information to make a correct diagnosis of PE, especially in the elderly. There are more new episodes of ischemic heart disease in the elderly followed by PE, but no significant difference in the overall SCVE between the two groups. The relationship between SCVE and age in patients with PE may need further evaluation.
 
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