Mitigating health disparities by improving access to catheter-based therapies for vulnerable patients with acute pulmonary embolism

Abstract Introduction This study explores the implementation and outcomes of catheter-based thrombectomy (CBT) in acute pulmonary embolism (PE) within a safety-net hospital (SNH), addressing a critical gap in the literature concerning CBT in underserved and vulnerable populations. Methods This is a retrospective study of patients undergoing CBT between October 2020 and January 2024 at a SNH. The primary outcome was 30-day all-cause mortality. Results A total of 107 patients (47.6% female, mean age 58.4 years) underwent CBT for acute PE, with 23 (21.5%) high-risk and 84 (78.9%) intermediate-risk PE. Demographically, 64% identified as Black, 10% White, 19% Hispanic or Latino, and 5% Asian. In terms of insurance coverage, 50% had private insurance or Medicare, 36% had Medicaid, and 14% were uninsured. Notably, 67% of the patients resided in high poverty rate zip codes and 11% were non-citizen non-residents. Markers of risk severity, such as biomarkers (troponin, BNP), PE risk classification (high versus intermediate-risk), rates of low CI, lactate level, CPES/sPESI score, and rates of RV dysfunction did not vary significantly across race/ethnic groups, insurance status, level of poverty and citizenship status. Over a median follow up period of 30 days, 6 (5.6%) patients expired (all high-risk PE), 3 of which presented with cardiac arrest. No patients who presented with intermediate-risk PE died at 30 days. There was no difference in 30-day mortality based on race, insurance type, poverty level or citizenship status. Conclusion The findings emphasize the feasibility and success of implementing PERT and CBT at a SNH, offering a potential model to address healthcare disparities in acute PE on a broader scale.