Important Signs of Pulmonary Embolism Missed in Patients With Dementia
September 22, 2021

Patients with dementia who had signs and risk factors of a pulmonary embolism were much less likely to be tested than patients without dementia who had the same signs and risk factors, according to a study published in the Journal of the American Geriatrics Society.

For example, physicians at baseline were about 1 percentage point less likely to test patients with dementia for pulmonary embolism than patients without dementia, and physicians were an additional 2.6 percentage points less likely to test patients with dementia who had an elevated heart rate -- a possible sign of a pulmonary embolism -- than to test those without dementia who had an elevated heart rate.

Dan P. Ly, MD, Veterans Affair (VA) Greater Los Angeles Healthcare System, Los Angeles, California, and colleagues sought to determine if the presence of dementia makes a difference in how physicians evaluate patients with shortness of breath for their risk of a potentially fatal pulmonary embolism. Specifically, they examined if clinical signs and risk factors of pulmonary embolism, such as a prior history of blood clots, recent cancer, recent surgery, and elevated heart rate, were evaluated differently for patients with dementia.

The researchers studied 593,000 emergency department visits to 104 Veterans Affairs hospitals between 2011 and 2018. The sample included 7,100 physicians. Patients were aged 60 years and older and presented with shortness of breath.

The researchers noted that the study was observational and there may have been other, non-observable factors that contributed to these results. The data also did not include care wishes of patients or their caregivers, and the results may be specific to VA patients and physicians and not applicable to non-VA populations.

“Clinical factors known to be predictive of pulmonary embolism risk had a lower association with pulmonary embolism testing for patients with dementia compared with patients without dementia,” the authors wrote. “These results may be consistent with physicians missing these clinical factors more often when evaluating patients with dementia, but also with physicians recognising such factors but not using them in the decision-making process. Further understanding how physicians evaluate patients with dementia presenting with common acute symptoms may help improve the care delivered to such patients.”

Reference: https://agsjournals.onlinelibrary.wiley.com/doi/10.1111/jgs.17438

SOURCE: University of California - Los Angeles Health Sciences