"There are fewer conditions in medicine that are so common, potentially deadly, in need of multidisciplinary care, and last but not least, largely preventable."
— Behnood Bikdeli, MD, MS
Pulmonary embolism, or PE, is a serious and sometimes life-threatening condition that occurs when a blood clot travels to the lungs and obstructs the flow of blood.
Despite advances in diagnosis and treatment, PE continues to be a significant health challenge—at least 400,000 hospitalizations each year in the US are due to pulmonary embolisms or complications related to PE.
Much of the care for PE is provided by cardiovascular specialists these days, from echocardiography to biomarkers to the recently emerged catheter-based advances to reduce the burden of blood vessel obstruction and reduce extra pressure on the heart.
In 2026, the American Heart Association and American College of Cardiology (ACC) released the first comprehensive clinical guidelines dedicated to PE, marking a major shift in how the condition is evaluated and managed.
Behnood Bikdeli, MD, MS
Gregory Piazza, MD, MS, Rachel Rosovsky, MD, MPH, and the late Ido Weinberg, MD of the Mass General Brigham Cardiovascular Institute were among the Writing Committee members.
Behnood Bikdeli, MD, MS, a clinician-investigator in cardiology at Mass General Brigham, was on the peer review committee for the new guidelines, which are the focus of the April edition of the Journal of the American College of Cardiology.
In this Q&A, Dr. Bikdeli discusses the new guidelines, the JACC spotlight issue, and recent studies that shed light on outcomes, trends and ongoing challenges in PE care.
Can you tell us about the new guidelines for pulmonary embolism?
A major advance in the new guidelines is the introduction of five clinical categories to better capture the wide range of PE severity.
This is important because PE can look very different from one patient to another, ranging from asymptomatic disease found on a CT scan performed for another reason to mild symptoms, or major clinical deterioration, all the way up to cardiac arrest.
The guidelines also emphasize that care does not end after the initial event. They recommend follow-up at three to six months to assess for post-PE syndrome, which can include persistent shortness of breath, fatigue, reduced exercise tolerance, difficulty returning to normal activities, and anxiety or depression.
Follow-up is also critical for reassessing the risks and benefits of ongoing blood thinner therapy and considerations for when and how to resume other routine daily activities.
What were your contributions to the April issue of the JACC?
In collaboration with the JACC Editor-in-Chief, we developed a full special issue centered on PE and the new guidelines.
I am a coauthor on four papers in the issue, serving as lead author on two and senior author on one. I also, with support from Dr. Harlan M, Krumholz, Dr. Erica Spatz, and JACC/ACC staff, served as the handling editor for the entire issue, inviting authors and overseeing the peer review process.
The issue brings together original research, guideline summaries, viewpoints, and commentaries that reflect the growing recognition of PE as a serious and complex condition requiring coordinated care.
There are fewer conditions in medicine that are so common, potentially deadly, in need of multidisciplinary care, and last but not least, largely preventable.
What did you learn from your study looking at 90-day trends after pulmonary embolism?
In this study, my team and were interested to learn whether advances in PE diagnosis and treatment over the past decade have improved short-term outcomes for patients.
Using data from the RIETE international registry, which included more than 31,000 adults treated for PE between 2016 and 2024, we evaluated trends in death, recurrent blood clots, and serious bleeding within 90 days of a PE.
We found that pulmonary embolism remains a serious condition with substantial risk.
About six to seven out of every 100 patients died within 90 days of a PE, and this rate remained largely unchanged over the study period, despite improved imaging and newer blood-thinning medications.
We should also emphasize that the registry includes all forms of PE, not just the most severe forms, in which up to one in five may die from PE even despite state-of-the-art therapies, as is similarly shown in an accompanying study by Dr. Rosovsky and colleagues using the PERT consortium database.
Rates of serious bleeding related to treatment also did not change meaningfully. One encouraging finding was a modest decline in recurrent blood clots, suggesting some improvement in preventing repeat events.
Overall, the results highlight that while care has advanced, significant challenges remain.
Can you tell us about the study on PE-related hospitalizations and mortality in the United States?
In a separate study, we analyzed data from the U.S. National Inpatient Sample, examining 1.3 million adults hospitalized with pulmonary embolism as the primary diagnosis between 2016 and 2022.
Hospitalization rates were generally stable, with an unexpected decline during 2020 and an increase in 2021 that coincided with the COVID-19 pandemic.
PE-attributable deaths, analyzed using the CDC data, showed a gradual increase over time especially in 2020 and 2021, when pandemic-related inflammation, immobility and clotting risk likely contributed to worse outcomes.
These findings underscore the ongoing burden of pulmonary embolism in the United States and the need for continued improvements in prevention, risk stratification and management, particularly during periods of healthcare system strain.
But they also unraveled issues with current tools available to us for surveillance, which have important limitations and tendencies for error.
In fact, we just received funding from AHA to improve the accuracy of surveillance through large databases and have other major efforts ongoing to address these issues.
We can’t improve prevention and treatment for pulmonary embolism unless we know how frequently it occurs and who it impacts.
How can improve our understanding of the impact of pulmonary embolism—and improve our strategies for diagnosis and treatment?
Data presented in this JACC Spotlight issue and related work show that pulmonary embolisms are frequent, can be fatal, and imposes substantial costs on patients and society.
Some estimates suggest that PE contributes to up to 50,000 deaths a year in the United States alone.
Yet the public and many policymakers remain unaware of this burden, and clinicians may not always be up-to-date on the optimal practices for diagnosis, acute management and follow‑up care.
It is our sincere hope that this Spotlight issue helps put practice on the right track across these fronts.
Subscribe to BenchMarks!
Subscribe to our monthly research newsletter and be the first to know what’s shaking in science at Mass General Brigham. From groundbreaking discoveries to the latest “you-heard-it-here-first” breakthroughs, we’ve got the updates that’ll keep your curiosity grooving.
Leave a Comment