Risk Stratification, Treatment Approach and Short-Term Outcomes of Acute Pulmonary Embolism in a Moroccan Tertiary Cardiology Department: A Retrospective Study

Abstract

Background: Acute pulmonary embolism (PE) is a major cardiovascular emergency associated with substantial morbidity and mortality, particularly when diagnosis is delayed. Because the clinical spectrum varies widely (mild dyspnea to near-cardiac collapse), it is important for clinicians to classify patients according to risk shortly after diagnosis so that they may use that classification to determine the level of treatment intensity and monitoring needed. There is very little information available about northern Africa tertiary cardiac care centers. The aim of this study was to describe the clinical characteristics, risk classification (based on the ESC guidelines), treatment patterns and short-term outcomes of patients with acute PE who were hospitalized in the Cardiology Department of Ibn Rochd University Hospital in Casablanca. Methods: A retrospective observational study was conducted to review and analyze the data of all consecutively hospitalized patients diagnosed with acute PE between January 2024 and December 2025 (a 2-year study period). Recorded demographic data, clinical presentation and treatment, as well as risk classification and in-hospital outcomes were collected through chart review. Patients were classified according to the latest ESC guidelines for risk classification dated 2019. Results: Twenty-two men and thirty-two women were included (n = 54); women accounted for 59.3% of the cohort. Mean age was 60 ± 18 years (range, 22–88 years). The most common predisposing factors were prolonged immobilization (81%), obesity (52%), recent surgery (28%), hormonal or postpartum exposure (28%), active cancer (15%), and previous venous thromboembolism (7%). High-risk PE was observed in 17% of patients, while intermediate-high-risk PE accounted for 44%. In addition, 39% of study patients were classified as intermediate-low risk. No patient in this study was classified as a low-risk patient. Anticoagulation was the first-line treatment for acute pulmonary embolism (acute PE), with 30% of patients taking direct oral anticoagulants, 30% receiving subcutaneous low-molecular-weight heparin, followed by oral vitamin K antagonists, 25% receiving intravenous unfractionated heparin followed by oral vitamin K antagonists, and 15% receiving subcutaneous low-molecular-weight heparin only. Five (9%) of the patients received systemic thrombolysis. The mean length of hospital stay was 7 ± 3 days; 87% required ICU admission during hospitalization. The in-hospital mortality rate was 9 out of 54 (16.7%). The high-risk group had 55.6% mortality (5 out of 9) and the intermediate-high-risk group had a 16.7% mortality (4 out of 24). In our cohort, most of the acute PE cases occurred in terms of early risk (intermediate/high early risks); included a transient provoking factor (patients had multiple factors that might cause them to experience acute PE) and were often obese. The large amount of in-hospital mortality associated with acute PE emphasizes the importance of early severity assessment, initiation of anticoagulation, appropriate escalation of treatment, and developing an organized written follow-up system after hospital discharge.