Gender disparities in high-risk pulmonary embolism: a nationwide analysis of management strategies and clinical outcomes

Pulmonary embolism (PE) remains a significant cause of cardiovascular mortality. Despite advancements in diagnosis and treatment, gender disparities in high-risk PE management and outcomes remain poorly understood. This study aimed to investigate gender-based differences in the presentation, treatment, and outcomes of patients with high-risk PE. We analyzed data from the National Inpatient Sample for patients with high-risk PE from 2016 to 2021. High-risk PE was defined as PE with cardiogenic shock, mechanical ventilation, mechanical circulatory support, or vasopressors. Multivariable logistic regression was used to examine gender-based differences in management and outcomes. Of 45,140 patients with high-risk PE, 51.4% were female. Female patients were older (mean age 65.2 vs. 63.4 years, p < 0.001) and more likely to present with cardiac arrest (35.4% vs. 30.4%, p < 0.001). After adjustment, females were more likely to receive systemic thrombolysis (aOR 1.17, 95% CI 1.11–1.23, p < 0.001) but less likely to undergo catheter-directed embolectomy (aOR 0.92, 95% CI 0.86–0.99, p = 0.034) or surgical embolectomy/thrombectomy (aOR 0.83, 95% CI 0.73–0.93, p = 0.002). Female patients experienced higher risk of all-cause mortality (aOR 1.22, 95% CI 1.18–1.27, p < 0.001) and major adverse cardiovascular and cerebrovascular events (aOR 1.21, 95% CI 1.16–1.25, p < 0.001). Significant gender disparities exist in the management and outcomes of high-risk PE. Female patients have higher mortality rates despite being more likely to receive systemic thrombolysis. Further research is needed to understand and address these disparities to improve outcomes for all patients with high-risk PE.