Contemporary national trends in the management of admissions for pulmonary embolism

Introduction Over the past decade, the inpatient management of pulmonary embolism has undergone a paradigm shift in response to new evidence and the adoption of catheter-directed reperfusion therapies. However, real-world practice patterns remain poorly characterized. Methods This study used Epic's Cosmos database to analyze admissions for pulmonary embolism in the United States between January 1, 2016, and December 31, 2024. Adult inpatient admissions for pulmonary embolism were identified by International Classification of Diseases, Tenth Revision codes documented in the Admit to Inpatient order. Admissions were stratified by severity using established high-risk criteria to allow for a risk-based comparison of treatment strategies. High-risk criteria included the presence of cardiogenic shock, cardiac arrest, the use of vasopressors, dobutamine, extracorporeal membrane oxygenation, or mechanical ventilation at any point during the admission; the remaining admissions were classified as non-high-risk. Trends in patient characteristics, anticoagulation strategies, reperfusion therapies, and cardiopulmonary support were analyzed across the study period. Results This study identified a total of 267,094 hospital admissions for pulmonary embolism (mean [SD] age, 63 [17] years; 51.4% female; 71.1% White) between 2016 and 2024. Of these admissions, 5.5% met one or more high-risk criteria, increasing from 4.3% in 2016 to 5.8% in 2024 ( p < 0.001). The proportion of patients receiving unfractionated heparin alone increased across non-high-risk (33.2% to 63.0%) and high-risk cases (53.7% to 66.3%). Among non-high-risk admissions, the utilization of reperfusion therapies nearly doubled (5.2% to 10.3%, p = 0.002), primarily driven by a rise in the use of catheter-directed embolectomy. In high-risk admissions, the overall use of reperfusion therapies remained stable (27%–34%, p = 0.135), while catheter-directed embolectomy emerged as the predominant modality. For hemodynamic support of high-risk admissions, vasopressor/dobutamine utilization increased (53.3% to 72.2%) as mechanical ventilation use declined (54.7% to 32.4%). Conclusions These findings help contextualize the extent to which novel therapies and evolving practice patterns have been integrated into real-world care in the United States. Catheter-directed embolectomy has become the dominant reperfusion strategy for pulmonary embolism, reflecting a major shift in practice.