Trends in Thrombolytic Treatment and Outcomes of Acute Pulmonary Embolism in Germany

The treatment approaches and in-hospital outcomes were analyzed for 885,806 patients with acute pulmonary embolism (PE) in Germany between 2005 and 2015. The incidence of acute PE increased from 85 per 100,000 in 2005 to 109 per 100,000 in 2015 [β 0.32 (0.26–0.38), P < 0.001]. During the same period, in-hospital case fatality rates decreased from 20.4% to 13.9% [β −0.51 (−0.52 to −0.49), P < 0.001]. The overall proportion of patients treated with systemic thrombolysis increased from 3.1% in 2005 to 4.4% in 2015 [β 0.28 (0.25–0.31), P < 0.001]. Thrombolysis was associated with lower in-hospital mortality rates in patients with hemodynamic instability, both in those with shock not necessitating cardiopulmonary resuscitation (CPR) or mechanical ventilation [odds ratio (OR) 0.42 (0.37–0.48), P < 0.001], and in patients who underwent CPR [OR 0.92 (0.87–0.97), P = 0.002]. This association was independent of age, sex, and comorbidities. However, systemic thrombolysis was administered to only 23.1% of hemodynamically unstable patients.