Time Trends in Cause-specific Mortality in Patients with Pulmonary Embolism Aged 50 Years and Older

Patients with pulmonary embolism (PE) have high mortality rates. However, data on cause-specific mortality trends in this population are limited.To study time trends in cause-specific mortality among PE patients aged ≥50 years, analyzed across three time periods: 2006-2011, 2012-2017, and 2018-2023. The secondary aims included examining mortality trends in matched controls and subgroups of PE patients.This nationwide Swedish register study included patients with a first-time PE and matched controls. We assessed 30-day and 31- to 365-day cause-specific mortality and employed age- and sex-adjusted Poisson regression for the relative risk (RR) for annual mortality trends.The study comprised 115,476 patients, with cancer as the leading cause of 30-day mortality, stable at 4.7% from 2006-2011 to 2018-2023 (RR 1.00; 95% confidence interval [CI]: 0.99-1.01). Mortality from fatal venous thromboembolism (VTE) decreased from 2.7 to 1.3% (RR 0.94; 95% CI: 0.93-0.95), and cardiovascular disease from 2.3 to 1.1% (RR 0.94; 95% CI: 0.93-0.94). The 31- to 365-day mortality from cancer was stable at 11.8% in 2006-2011 and 11.4% in 2018-2022 (RR 1.00; 95% CI: 0.99-1.00), while mortality due to cardiovascular disease decreased from 4.1 to 2.3% (RR 0.96; CI: 0.95-0.96), and fatal VTE from 0.8 to 0.5% (RR 0.95; 95%: 0.93-0.96). Subgroup analysis showed a decrease in cancer-related mortality among PE patients with known cancer, while it increased in those without known cancer.Cancer was the leading cause of death in PE patients aged ≥50 years, with stable rates over time due to contrasting trends in patients with and without known cancer. Fatal VTE comprised a minor percentage of overall mortality in recent years.