Pulmonary embolism at Landspitali, The National University Hospital of Iceland 2005-2007-Incidence, clinical manifestations, risk factors and outcome

Introduction: Pulmonary embolism is a serious disease and common among hospitalized patients. The incidence of pulmonary embolism in Iceland is largely unknown. The purpose of this study was to evaluate the incidence, clinical presentation, risk factors and outcome among patients diagnosed with pulmonary embolism at Landspitali, The National University Hospital of Iceland. Material and methods: A retrospective analysis of medical records of patients diagnosed with the ICD-10 diagnosis 126 (Pulmonary embolism) between 2005-2007 was carried out. Data were retrieved on age, clinical manifestations, treatment, risk factors, diagnostic procedures and outcome. Results: The total number of patients was 312 and the in-hospital incidence was 5 per 1.000. Thirty day mortality was 9.9% (95% Cl 6.6-13.3). Dyspnea was the most common symptom (81%) and diagnosis was most often established by computed tomography of the pulmonary vasculature (88,8%). Anticoagulation was by far the most common management (96%) but thrombolysis, thrombectomy or use of inferior vena cava filters were very rare. The frequency of atrial fibrillation was significantly higher in patients with pulmonary hypertension by echocardiography than without, 32.4% and 9.7%, respectively (p=0.026). Thirty day mortality was significantly higher in women than in men (13.2% versus 6.5%, p=0.049), and in patients with no classic symptoms of pulmonary embolism at diagnosis (36.4% versus 8.1%, p=0.012). Discussion: The hospital incidence of pulmonary embolism, 5/1000 patients, at Landspitali The National University Hospital of Iceland is higher than found in similar studies in many other countries. Mortality, while similar, has fallen markedly during the past 40 years.