Abstract
Treatment options for acute pulmonary embolism (PE) have evolved rapidly, with an increasing number of interventional options, necessitating interhospital transfer for consideration of advanced therapies and optimal care. Utilizing the National PERT Consortium database, this study analyzed 12,346 patients from 35 institutions between October 16, 2015 and June 1, 2024. Patients were categorized as directly presenting to a PERT hospital or transferred from a referring hospital. Demographics, clinical presentations, treatments, and outcomes were compared. Multivariable logistic regression was used to evaluate the association between transfer status and outcomes. Transferred patients (n = 3277) were younger, more frequently White, more often obese, and had lower malignancy rates. They were more likely to be classified as high-risk PE (16.7% vs. 13.8%, p < 0.01) and intermediate-high risk PE (55.9% vs. 54.3%, p < 0.01). Transferred patients more frequently received advanced therapies, including ECMO (2.8% vs. 1.1%, p < 0.01), surgical embolectomy (2.0% vs. 0.8%, p < 0.01), systemic thrombolysis (5.3% vs. 3.8%, p < 0.001), and catheter-based interventions (32.3% vs. 17.1%, p < 0.01). After adjustment, transfer was associated with lower odds of 30-day mortality (OR 0.82, 95% CI 0.69-0.98), 1-year mortality (OR 0.77, 95% CI 0.67-0.89), and in-hospital mortality (OR 0.78, 95% CI 0.65-0.97), with no significant difference in major bleeding risk. Subgroup analysis showed mortality benefits were most evident among intermediate-low and high-risk patients. In conclusion, acute PE patients transferred to PERT hospitals were more likely to receive advanced therapies and had improved short- and long-term survival, with no increase in bleeding risk, despite presenting with higher clinical severity.