Nationwide Disparities in Treatment of High Risk Pulmonary Embolism: A Five-year Comparative Analysis of Catheter-directed Therapies vs. Anticoagulation in the US Inpatient Population

Monday, March 31, 2025

4:03 PM – 4:12 PM CT

Location: Music City Center, 201 AB

Presenting Author(s)

Taha Lodhi

Medical Student
Brody School of Medicine, United States

Author/Co-author(s)

TE

Tarig Elhakim, MD

Medicine Instructor & Research Associate
Penn (Medicine Instructor) & MGH (Research Associate), United States
MD

Michael Dezube, None

Senior Data Scientist
Massachusetts General Hospital, United States
Wilton Fidelis

Medical Student
Georgetown University School of Medicine, United States
SD

Samuel Davis, PhD

Data Scientist
Massachusetts General Hospital, United States
DD

Dania Daye, MD, PhD

Associate Professor
Massachusetts General Hospital/Harvard Medical School, United States

Purpose: To analyze the use of catheter-directed treatment (CDT) versus anticoagulation for high-risk pulmonary embolism (PE) and to assess disparities in treatment access.

Materials and Methods: The National Inpatient Study data was obtained from the Healthcare Cost and Utilization Project, Agency for Healthcare Research and Quality. From 2016 to 2020, we identified patients with high-risk PE using ICD-10 codes and analyzed the utilization trends of CDT, including thrombolysis and embolectomy, compared to systemic anticoagulation. Multivariate logistic regression was used to evaluate the effect of age, sex, race, location, payer, median household income, and hospital characteristics.

Results: Of 96,305 encounters with high-risk PE, 19,009 (19.7%) received CDT. Compared to males, CDT was utilized less often in females (OR: 0.92, 95% CI: 0.86-0.99, P=0.034). Compared to White patients, CDT was less utilized in Black (OR: 0.84, 95% CI: 0.76-0.93, P=0.001), Hispanic (OR: 0.81, 95% CI: 0.67-0.98, P=0.031), and other races (OR: 0.71, 95% CI: 0.54-0.94, P=0.015). Compared to patients with private insurance, those on Medicaid, Medicare and self-pay were less likely to receive CDT (OR: 0.61, 95% CI: 0.53-0.70, P< 0.001, OR: 0.65, 95% CI: 0.59-0.72, P< 0.001 and OR: 0.79, 95% CI: 0.65-0.96, P< 0.001, respectively). Compared to rural hospitals, urban nonteaching (OR: 2.47, 95% CI: 1.99-3.07, P< 0.001) and teaching hospitals (OR: 2.71, 95% CI: 2.22-3.31, P< 0.001) were associated with higher utilization of CDT. Higher use was also seen with medium (OR: 1.14, 95% CI: 1.02-1.28, P=0.024) and large bed size hospitals (OR: 1.37, 95% CI: 1.23-1.51, P< 0.001). as. Compared to central metropolitan counties with over 1 million people, CDT use is lower in metro counties with under 1 million people (OR: 0.85, 95% CI: 0.76-0.95, P=0.001). Finally, the use of CDT was higher in 2020 compared to 2016 (OR: 1.89, 95%, CI: 1.65-2.16, P< 0.001).

Conclusion: Since 2016, CDT has become more common for the treatment of high-risk PE. Women, Blacks, Hispanics and those with Medicare, Medicaid or self pay have a lower likelihood of CDT. Further assessment of these observed disparities is needed to ensure equitable treatment access.