Abstract 14219: Are There Sex Differences in the Imaging Modalities and Early Use of Echocardiography in Elderly Patients With Pulmonary Embolism?

Background: Sex differences in symptoms of acute pulmonary embolism (PE) in older adults (aged ≥65 years) may correlate with differences in the imaging modality used for confirming PE. It is also unknown if sex disparities exist in early use of echocardiography for prognostication. Methods: Using data from RIETE, a prospective multinational registry of patients with venous thromboembolism, we included older adults with acute PE. We compared the diagnostic modalities that were used in women vs men to confirm PE. We assessed the presenting symptoms/signs, thrombus location in patients diagnosed with computed tomography pulmonary angiography (CTPA), and evaluated PE severity according to the simplified Pulmonary Embolism Severity Index (sPESI) and the European Society of Cardiology (ESC) categories. We investigated the use of echocardiography within 3 days of PE diagnosis by sex. Results: REITE had 33,462 PE patients ≥65 years old including 19,294 women (mean age: 78.6±7.4 years) and 14,168 men (mean age: 76.1±7.2 years). CTPA was the dominant modality for PE diagnosis in both sexes, although a slightly smaller proportion of women were diagnosed with CTPA (77.1 vs 79.4, P<0.001). There were no sex differences in the proportion of patients presenting with isolated subsegmental PE (5.0%; 99% CI, 4.6-5.5% vs 5.5% 99% CI, 5.0-6.0%). There were no clinically relevant sex differences according to sPESI or the ESC risk categories (Table). Women were not less likely, indeed slightly more likely, than men to undergo echocardiography within 3 days of PE diagnosis (51.1%; 99% CI, 50.3-51.9% vs 48.9%; 99% CI, 48.0-49.8%). Conclusions: Slightly greater use of CTPA for diagnosing PE in men compared to women may reflect more chest pain and hemoptysis on presentation in men. However, there is similar illness severity in elderly men and women and minimal disparity in early use of echocardiography after diagnosis for prognostication.