Abstract Background The COVID-19 pandemic disrupted healthcare systems, potentially altering acute pulmonary embolism (PE) outcomes. This study evaluates pandemic-era shifts in PE mortality, admissions, and resource utilization across two distinct periods: pre-pandemic (2016-2019) and pandemic-era (2020-2021). Methods Retrospective cohort analysis of 1, 069, 170 acute PE hospitalizations (2016–2021) from the U. S. National Inpatient Sample. Primary outcomes included in-hospital major adverse cardiovascular/cerebrovascular events (MACCE), mortality, and major bleeding. Secondary outcomes assessed admission rates, length of stay (LOS), and costs. Multivariable logistic regression adjusted for age, sex, comorbidities, and hospital characteristics. Results Annual acute PE admissions declined from 55. 9/100, 000 population (2019) to 50. 2/100, 000 (2021). In-hospital mortality peaked at 3. 4% in 2020. Pandemic-era (2020–2021) patients demonstrated higher acuity: cardiac arrest (2. 0% vs. 1. 6%), saddle PE (11. 0% vs. 8. 7%), high-risk PE (4. 6% vs. 4. 0%), cardiogenic shock (1. 6% vs. 1. 4%), acute cor pulmonale (11. 6% vs. 7. 7%), longer mean LOS (4. 4 vs 4. 3 days) and total charge (57, 709 vs. 48, 436; all p0. 001). Adjusted analyses revealed pandemic-era reductions in catheter-directed thrombolysis (aOR 0. 89, 95% CI 0. 87 – 0. 91) but increased catheter-directed embolectomy (aOR 4. 95, 95% CI 4. 81 – 5. 10). Major bleeding (aOR 1. 13, 95% CI 1. 10 – 1. 16) and intracranial hemorrhage (aOR 1. 27, 95% CI 1. 20 – 1. 34) rose significantly (p0. 001), while mortality remained unchanged (aOR 1. 0, 95% CI 0. 96–1. 03). Conclusion The pandemic correlated with reduced acute PE admissions, increased disease severity, and shifts in procedural management. While mortality rates stabilized after adjustment, complications escalated, highlighting resource strain and potential care delays. These findings underscore the need for adaptive care protocols during public health crises. Admission and Mortality Rates 2016-2021
Gatuz et al. (Sat,) studied this question.