Top Things to Know: Disparities in Current Pulmonary Embolism Management and Outcomes
Published: March 20, 2025
Prepared by Edwin Takahashi, MD; Katherine Sheehan, PhD
- There are significant racial and ethnic differences in the incidence of pulmonary embolism (PE). For example, Black patients have the highest incidence rates of PE compared to other racial groups, including White, Asian, American Indian or Alaska Native, and Native Hawaii or Pacific Islander populations.
- Risk factors such as pregnancy, oral contraception, hormone replacement and childbearing age increase PE risk for females, compared to males.
- Among the transgender community, evidence suggests that gender-affirming hormonal therapy for transfeminine persons is associated with an increased risk of PE.
- Disparities in medical imaging, particularly the underutilization of CT imaging for diagnosing PE, may be influenced by geographic, socioeconomic, and racial factors. Conversely, female patients with suspected PE may be more likely to undergo low-yield CT scans, leading to increased radiation exposure without corresponding diagnostic benefit.
- Among PE patients, females, underrepresented racial and ethnic groups, and rural-dwelling individuals are less likely to receive advanced therapies for PE treatment such as systemic thrombolysis or catheter-directed procedures.
- While more data is needed to assess disparities related to post-PE syndrome, racial, ethnic, sex, and socioeconomic disparities in PE-related morbidity, including the incidence and treatment of chronic thromboembolic pulmonary hypertension, have been recognized.
- Significant PE-related mortality disparities have been identified among Black and Hispanic populations as well as in females and socioeconomically disadvantaged individuals.
- More public education about the signs and symptoms of PE, along with the appropriate steps to take if PE is suspected, is crucial for ensuring timely treatment. Educational strategies should prioritize high-risk populations by tailoring messages to effectively reach and inform those most at risk.
- Collaboration between public health initiatives and professional organizations may help to improve PE awareness and management in underserved or disenfranchised communities.
- Enhancing diversity in both clinical trial enrollment and leadership may produce more inclusive and comprehensive data for the management of PE in populations that are currently underrepresented in research.
Citation
Takahashi EA, Sista AK, Addison D, Bikdeli B, Bishay VL, Gu S, Hood MN, Litmanovich D, Misra S, Reddy G; on behalf of the American Heart Association Council on Cardiovascular Radiology and Intervention; Council on Cardiovascular and Stroke Nursing; Council on Clinical Cardiology; and Council on Peripheral Vascular Disease. Disparities in current pulmonary embolism management and outcomes: a scientific statement from the American Heart Association. Circulation. Published online March 20, 2025. doi: 10.1161/CIR.0000000000001306