Elderly COPD Patients at Disproportionately Higher Risk of PE-related Deaths

Patients with chronic obstructive pulmonary disease (COPD), particularly those aged 65–85 years, face a significantly increased risk of fatal pulmonary embolism (PE), according to findings presented at the American College of Chest Physicians (CHEST) 2024 Annual Meeting held in Boston in early October.¹

This study assessed how COPD influences age-specific mortality patterns related to PE, utilizing data from the Centers for Disease Control and Prevention’s WONDER database (1999–2020). Mortalities were categorized based on whether COPD was listed as a multiple cause of death and further stratified by 5-year age bands from 35 years to over 100 years. Proportional mortality ratios in individuals without COPD were estimated and applied to COPD-positive groups across age categories to evaluate observed versus expected deaths.

A total of 10,434 deceased patients with PE identified as the underlying cause of death and COPD recorded as a multiple cause of death were included in the analysis. Of these, 5,181 (approximately 50%) were females, yielding a near 1:1 female-to-male ratio. The highest number of deaths occurred in COPD patients aged 75–84 years.

Age-specific risk analysis demonstrated that PE-related mortality was significantly elevated in COPD patients aged 65–85 years, with the greatest disproportion observed in the 75–79 years age group (observed-to-expected ratio: 1.443). In those aged ≥85 years, observed deaths were similar to expected values, suggesting that the impact of COPD on PE-related mortality diminishes in the oldest age groups. Among individuals aged 35–64 years, none of the 5-year age cohorts exhibited a significantly increased risk of PE-related mortality.

COPD is a recognized risk factor for PE. This retrospective analysis highlights the age-specific impact of COPD on PE-related mortality and underscores the need for heightened vigilance, appropriate thromboprophylaxis, and targeted management strategies in high-risk COPD populations. Individualized decision-making—balancing the benefits and risks of more intensive thromboprophylaxis—is essential, particularly in older patients who often have multiple comorbidities contributing to elevated PE risk.

Reference

1. Zahergivar A, et al. Age-specific patterns of pulmonary embolism-associated mortality in patients with chronic obstructive pulmonary disease: insights from a retrospective database analysis. Chest. Oct 2024;166(Iss 4 Suppl):A4989. DOI: https://doi.org/10.1016/j.chest.2024.06.2959