Y HOC TP HO CHI MINH · Feb 14, 2026
Clinical and paraclinical characteristics of older patients with acute pulmonary embolism
By Le TBN, Nguyễn VT, Viên BÁ
BACKGROUND: Acute pulmonary embolism is a common cardiovascular emergency with a high mortality rate in older adults. In this group, clinical presentations are often atypical, and the burden of multimorbidity and frailty may affect risk stratification and in-hospital outcomes. OBJECTIVE: To describe clinical and paraclinical characteristics, risk stratification, and frailty status in older patients with acute pulmonary embolism. SUBJECTS AND METHODS: A retrospective descriptive study of patients ≥ 60 years of age admitted to Thong Nhat Hospital and Cho Ray Hospital from 01/2019–07/2024 with acute pulmonary embolism confirmed by contrast-enhanced computed tomography of the chest or pulmonary arteries. Clinical data, electrocardiography, echocardiography, laboratory tests, and thrombus locations on CT were collected; risk was stratified according to PESI/sPESI and ESC 2019; frailty was determined using the Hospital Frailty Risk Score (HFRS). RESULTS: The study included 237 patients, with a median age of 74 [68–81]; women accounted for 73%. Common comorbidities were hypertension (65%) and diabetes mellitus (32.9%); a common risk factor was bed rest > 3 days (19.4%). Dyspnea (68.8%) and chest pain (38.4%) were common symptoms; altered mental status occurred in 16.5%, respiratory failure in 60.8%, and hypotension in 15.6%. Echocardiography showed pulmonary hypertension in 54.9%, right ventricular dilation in 41.8%, and TAPSE <16 mm in 38.0%; lower-extremity deep vein thrombosis was present in 45.1% (proximal 38.8%). D-dimer and NT-proBNP were elevated, with medians of 6466 ng/mL and 1226 pg/mL, respectively. Risk stratification showed that PESI classes III–V accounted for 80.2%; according to ESC 2019, intermediate risk accounted for the majority (76.8%) and high risk for 14.8%. The prevalence of frailty according to HFRS (≥ 5 points) was 48.1%. Initial treatment was primarily low-molecular-weight heparin (78.5%); reperfusion by thrombolysis was performed in 14.3%. Common in-hospital complications included infection (27%), acute kidney injury (26.2%), transfer to ICU/CCU (24.5%), bleeding (6.8%), and death (9.3%). In multivariable logistic regression analysis, factors associated with in-hospital mortality included age ≥ 85 (p = 0.018), cancer (p = 0.014), COPD (p = 0.027), frailty according to HFRS (p = 0.004), and systolic blood pressure <90 mmHg (p <0.001); obesity (p = 0.017). The reduced Firth model identified blood pressure < 90 mmHg (OR 8; 95% CI: 2.930–21.775) and HFRS (OR 11.2; 95% CI: 1.976–63.964). CONCLUSIONS: Older patients with acute pulmonary embolism have a high burden of multimorbidity and a high prevalence of frailty, with most at intermediate–high risk, accompanied by a substantial rate of in-hospital complications. Integrating frailty screening into risk stratification may support individualized treatment and comprehensive care for older adults.