Sex Differences Among Patients Who Received a Pulmonary Embolism Response Team Activation

Multidisciplinary Pulmonary Embolism Response Teams (PERTs) have increased in popularity as treatments available for acute PE have evolved. There is little known about biological sex differences in clinical characteristics, interventions, and outcomes of patients for whom PERT is activated.

This is a retrospective multicenter cohort study of adult patients for whom PERT was activated from 2016 to 2024. We included patients with radiographically confirmed PE. We obtained clinical and demographic data retrospectively from the electronic medical record from a trained data analyst and abstractors. We performed univariate analyses using Cochran-Mantel-Hanzel and ANOVA tests. We used a post double selection LASSO approach to select among >20 a priori specified covariates to yield final adjusted models for each of the following outcomes: receipt of advanced therapy (systemic thrombolysis, catheter-directed therapy [CDT], surgical embolectomy, or extracorporeal membrane oxygenation), catheter-directed therapy, 7- and 30-day mortality, and 30-day major bleeding. Data analysis was performed using R software, version 4.5.1.

We studied 2602 patients across two clinical sites, 50.3% of whom were female. Females were slightly older, (62.9 vs 61.7 years, p=0.06), had higher BMIs (33.6 vs 31.7, p< 0.001) and were less likely to be full code (84% vs 90%, p = 0.048). Females had a higher prevalence of chronic lung disease (p = 0.016), and lower prevalence of liver disease (p = 0.043) and chronic kidney disease (p = 0.013). Congestive heart failure, GI bleeding, malignancy, and stroke were similar across sexes. A higher proportion of females had high-risk PE (9.5% vs 6.3%, p = 0.011), consistent with the higher prevalence of hypotension in this group (26.2% vs 22.3%, p=0.007). In adjusted analyses (odds ratio, 95% CI), sex was not associated with 7-day mortality 1.07 (0.70–1.64), 30-day mortality 1.07 (0.77–1.49), 30-day major bleeding 1.25 (0.91–1.72), or receipt of advanced therapy 1.16 (0.81–1.65).

Although baseline characteristics and PE severity differed by sex among patients triggering PERT activation, sex was not independently associated with mortality, bleeding or advanced therapy use.