• Pulmonary embolism

I read with interest the editorial in Thorax entitled ‘Identification of those at risk after acute pulmonary embolism’.1 In the second paragraph, the authors state and reference the inpatient mortality for normotensive patients with acute PE as ∼10%.

My concern is twofold. First it is that readers may surmise that the mortality of acute treated PE is as quoted, when in reality the all-cause out of hospital 3 month mortality of those with PE is 9% in the reference quoted. This level of mortality relates not just to the PE but to the co-morbidities, such as cancer, that this cohort frequently possess. Secondly, in clinical experience it seems a rarity that those even with a large clot burden identified on CT pulmonary angiography (CTPA) and without life-threatening co-morbidities do not improve their clinical state once treated with anticoagulation. Do the editors know of any studies that clearly identify the cause of death systematically in those with PE so that we can truly pick out the mortality associated with this diagnosis?