Shah, S H

Abstract Rationale Pulmonary hypertension (PH) is a progressive, heterogeneous group of disorders leading to right heart failure and death. Despite advances in management, population-level mortality trends among older adults remain poorly characterized. Understanding these long-term trends is essential for designing equitable, population based interventions. Methods We analyzed mortality data for adults aged 65 years and above using the CDC WONDER database from 1999 to 2020. PH related deaths were identified using ICD 10 codes (I27.0, I27.2,I27.8,I27.9). Age adjusted mortality rates (AAMR) per 100,000 population were calculated and stratified by sex, race and comorbid conditions including hypertension, type 2 diabetes mellitus and congestive heart failure. Temporal trends were evaluated using joinpoint analysis to estimate average annual percent change (AAPC) with corresponding p-values. Results From 1999 to 2020, a total of 141,243 PH related deaths occurred among US adults aged 65 years and above, corresponding to an overall AAMR of 9.1 per 100,000 (95% CI, 8.9-9.3). Annual mortality increased from 5.2 in 1999 to 13.4 in 2020, a 2.6-fold rise (AAPC +3.8%; p < 0.001). Females accounted for 63.7% of all PH deaths and had higher mortality than males (10.8 vs 7.2 per 100,000). Black individuals experienced the highest mortality (12.5 per 100,000), exceeding rates among White (8.7) and Hispanic (7.9) counterparts. The proportion of PH deaths associated with cardiometabolic comorbidities rose substantially, with the largest annual increase seen in PH with coexisting HTN (+4.9% per year), followed by CHF (+4.6%) and T2DM (+4.1%). Conclusions Despite therapeutic progress, overall PH related mortality among older U.S. adults rose significantly from 1999 to 2020. Persistent sex and race based disparities highlight inequities in disease burden and access to care. The increasing coexistence of cardiometabolic comorbidities suggests evolving pathophysiology and emphasizes the need for prevention focused, multidisciplinary strategies. Future work should explore modifiable risk factors and healthcare system determinants driving these trends to inform targeted public health and policy interventions. This abstract is funded by: None

Abstract Rationale High and intermediate risk pulmonary embolism (PE) contributes significantly to in hospital morbidity and 5-10% of in hospital deaths. Thrombolytic therapy either via systemic intravenous tissue plasminogen activator (IV-tPA) or catheter directed thrombolysis (CDT) remains central to management, however, comparative national data on utilization and outcomes of thrombolytic therapy for PE remain limited. Methods Using the National Inpatient Sample data from 2010 to 2021, adult hospitalizations for acute PE were identified using ICD 9 code 415.1 and ICD 10 code I26. Cases receiving IV-tPA or CDT were identified using procedural codes. Temporal trends, in-hospital mortality, length of stay (LOS) and complications were compared between treatment groups using weighted analyses. Results Among 1,940,718 hospitalizations with acute pulmonary embolism, the use of thrombolytic therapy increased from 2010 to 2021 for both systemic intravenous tissue plasminogen activator (IV-tPA) and catheter-directed thrombolysis (CDT). Utilization of IV-tPA rose from 1.8% to 2.%, while CDT increased from 1.4% to 3.9%. Compared to IV-tPA, patients treated with CDT were more likely to be older (42.7% vs 39.3% were aged 65 years or above) and male (50.8% vs 48.7%). CDT was associated with significantly lower in hospital mortality (6.7% versus 11.1%, p < 0.01), shorter median length of stay (5 versus 6 days, p < 0.01) and fewer discharges to facilities (13.7% versus 19.4 %, p < 0.01). Rates of major complications were lower in the CDT group, including intracranial hemorrhage (0.4% versus 1.2%), cardiac arrest (1.7% versus 7.3%), myocardial infarction (4.7% versus 5.1%) and need for mechanical ventilation (6.7% versus 16.1%). However, use of extracorporeal membrane oxygenation (0.7% versus 0.2 %) and surgical embolectomy (1.2% versus 0.7%) was higher among CDT patients. Conclusions From 2010 to 2021, utilization of thrombolytic therapy, particularly catheter-directed techniques increased among PE hospitalizations. CDT was associated with lower in hospital mortality, shorter stays and fewer complications compared to systemic IV-tPA. These findings support the expanding role of catheter based interventions as a preferred therapeutic approach for patients with high and intermediate risk pulmonary embolism. Further prospective studies are warranted to confirm long term outcomes and optimize patient selection for CDT. This abstract is funded by: None