PURPOSE: Although congestive heart failure (CHF) is a known risk factor for pulmonary embolism (PE), little is known about the frequency of death from PE in patients who die with CHF. Some studies have reported PE as the cause of death in 9% and 32% of autopsied patients who died with CHF. In other studies, PE was found in the wide range of 0.4% to 50% of autopsied patients who died with CHF, but whether PE caused or contributed to these deaths was not stated. We undertook this investigation to determine the frequency of PE as the cause of death in patients (> 20 years of age) who died with CHF based on data from death certificates, as listed by the United States Bureau of the Census.
METHODS: Death from PE among adult patients (> 20 years of age) who died with CHF was determined from the United States Bureau of the Census Compressed Mortality File . We analyzed deaths from 1980 through 1998.
RESULTS: Among adults with CHF who died over the 19-year period of study, PE was the listed cause of death in 20,387 of 755,807 (2.7%). Assuming that the accuracy of death certificates was only 26.7%, the rate of death from PE in these patients may have been as high as 10.1%. The frequency of death from PE in patients who died with CHF decreased from 5.0% in 1980 to 1.6% in 1998.
CONCLUSION: In conclusion, the estimated death rate from PE in patients who died with CHF is 3% to 10%. A decline over two decades in the proportion of deaths from PE in such patients is compatible with an increasing and effective use of antithrombotic prophylaxis.
CLINICAL IMPLICATIONS: The decreasing rate of fatal PE among patients who died with CHF during the 19 year period of study presumably reflects an improvement in achieving an early diagnosis and more vigorous prophylaxis.
DISCLOSURE: Afzal Beemath, None.