Association Between Heart Rate at Diagnosis and Long-Term Recurrence Risk of Pulmonary Embolism in a Historical Cohort Study of Elder Women.

Abstract

To investigate the association between heart rate (HR) at diagnosis and long-term pulmonary embolism (PE) recurrence among elderly (≥ 50 year-old) female patients after acute PE (APE). Hospitalized patients with APE were grouped separately according to whether they experienced recurrent PE and whether the HR was  < 80 beats/min. Logistic regression and COX regression analysis were employed to assess the risk of PE recurrence. Kaplan-Meier method was applied to compare the recurrence-free survival of PE recurrence. Eighty-five patients were included, including 24 ones with HR < 80 beats/min and 11 recurrent PE cases. The mean time of PE recurrence were 71.7 ± 26.9 months (n = 6) and 27.7 ± 25.2 months (n = 5) among the patients with low HR and with high HR, respectively (P < .001). The HR (< 80 beats/min) was a negative predictor of PE recurrence (OR 0.071 (0.090-0.572), P = .013; HR 0.091 (0.016-0.523), P = .007), even after the adjustment for age, BMI, albumin, risk stratification, surgery, immobility ≥ 4 days, the blood cells counts, bilirubin and complications. The cumulative recurrence-free rates of PE recurrence at the 1^st-, 2^nd-, 5^th-, and 10^th-years for the low HR group were 100%, 100%, 87.5%, and 58.3%, compared to the 1^st-, 2^nd-, and 3^rd-years of 94.0%, 93.4%, and 48.0% for the high HR group (log-rank = 0.019). The low HR (< 80 beats/min at diagnosis) among elderly (≥ 50 years old) female patients at APE diagnosis would benefit to the long-term PE recurrence. But limited recurrent cases should be noted.