Behnood Bikdeli, MD, MS
Brigham and Women's Hospital
Medicine, Cardiovascular Medicine
Behnood Bikdeli, Alfonso Muriel, Yun Wang, Gregory Piazza, Candrika D Khairani 2, Rachel P Rosovsky, Ghazaleh Mehdipoor, Michelle L O'Donoghue, Olga Madridano, Juan Bosco Lopez-Saez, Meritxell Mellado, Ana Maria Diaz Brasero, Elvira Grandone, Primavera A Spagnolo, Yuan Lu, Laurent Bertoletti, Luciano López-Jiménez, Manuel Jesús Núñez, Ángeles Blanco-Molina, Marie Gerhard-Herman, Samuel Z Goldhaber, Shannon M Bates, David Jimenez, Harlan M Krumholz, Manuel Monreal 28; RIETE Investigators
Background: Sex-specific factors are implicated in pulmonary embolism (PE) presentation in young patients, as indicated by increased risk in pregnancy. Whether sex differences exist in PE presentation, symptomatology and therapies in older adults, the age group in which most PEs occur, remains unknown.
Methods: We identified older adults (aged ≥65 years) with PE in a large international PE registry replete with information about relevant clinical characteristics (RIETE registry, 2001-2021). To provide national data from the US, we assessed sex differences in clinical characteristics and risk factors of Medicare beneficiaries with PE (2001-2019).
Results: The majority of older adults with PE in RIETE (19,294/ 33,462, 57.7%) and in the Medicare database (551,492/ 948,823, 58.7%) were women. Compared with men, women with PE less frequently had atherosclerotic diseases, lung disease, cancer, or unprovoked PE, but more frequently had varicose veins, depression, prolonged immobility, or history of hormonal therapy (P<0.001 for all). Women less often presented with chest pain (37.3% vs 40.6%) or hemoptysis (2.4% vs 5.6%) but more often with dyspnea (84.6% vs 80.9%) (P<0.001 for all). PE risk categories were comparable between women and men (3.4% of women and 3.3% of men considered as high-risk PE according to ESC criteria, and 3.9% vs 3.3% with intermediate-high risk PE). Elderly women with intermediate-high risk PE were less likely to receive fibrinolytic therapy than me (8.0 vs 12.1%, standardized difference: 13.9%).
Conclusions: PE is more common in elderly women than men. Sex differences include the higher relative frequency of transient risk factors in women and cancer and cardiovascular diseases in men. Elderly women with intermediate-high risk PE were less likely to be offered fibrinolysis. Whether differences in risk factors and disparities in therapies correlate with differences in short- or long-term clinical outcomes warrants further investigation.