Impact of Patent Foramen Ovale on In-Hospital Outcomes in Acute Pulmonary Embolism

Q: How did the study define and compare patients with acute pulmonary embolism with and without PFO?

Adults hospitalized with acute PE from 2016 to 2020 were identified in the National Inpatient Sample using ICD-10 codes. Patients were grouped according to whether they had concomitant PFO, and clinical characteristics, advanced therapies, and in-hospital outcomes were compared.

Q: What were the key findings regarding clinical severity in patients with PFO?

Patients with concomitant PE and PFO were younger and showed more severe features, including higher rates of saddle PE and cor pulmonale, and they required more frequent interventions such as catheter-directed thrombolysis.

Q: Did PFO presence increase in-hospital mortality in this analysis?

No. After multivariable adjustment, PFO presence was associated with increased adjusted odds of stroke and peripheral embolism, but it was not associated with higher in-hospital mortality (aOR 0.9; P = 0.702).

Q: What does the study conclude about future research needs?

PFO in acute PE was linked to greater clinical severity and more frequent advanced interventions. Prospective studies are needed to define optimal screening strategies.

Sep 28, 2026

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Background: Patent foramen ovale (PFO) may worsen acute pulmonary embolism (PE) through paradoxical embolism, yet its clinical effect is uncertain. Methods: Using the National Inpatient Sample, adult patients with acute PE (2016–2020) were identified by ICD-10 codes and compared by presence of concomitant PFO, assessing characteristics, advanced therapies, and in-hospital outcomes with multivariable logistic regression. Results: Among 903,230 patients, 4,860 (0.54%) had PFO, with greater severity and increased adjusted odds of stroke and peripheral embolism. Conclusion: PFO is linked to higher severity and more advanced interventions; prospective studies are needed to define screening strategies.

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Original Article Cardiol Res. 2025;16(6):499-506 Impact of Patent Foramen Ovale on In-Hospital Outcomes in Acute Pulmonary Embolism Ahmad Jabria, Sant Kumarb, Mohamed Zghouzic, Mohamed Farhan Nasserd, Anand Maligireddye, Raef Fadelc, Brian O’Neillc, Pedro Villablancac, Pedro Engel-Gonzalezc, Tiberio Frisolic, Herbert D. Aronowc, f, Mohammad Alqarqazc, Gennaro Giustinoc, Herman Kadoa, Amr Abbasa, VikasAggarwalc, g Abstract Background: Patent foramen ovale (PFO) may complicate acute pulmonary embolism (PE) by enabling paradoxical embolism, but its clinical impact remains unclear. We evaluated the characteristics, management, and outcomes of patients hospitalized with PE with or without PFO. Methods: Using the National Inpatient Sample database, adult patients admitted with acute PE between 2016 and 2020 were identified via ICD-10 codes. Patients were grouped based on whether they had concomitant PFO. Clinical characteristics, advanced therapies, and in-hospital outcomes were compared between patients with and without PFO. Multivariable logistic regression analyses were adjusted for demographics and comorbidities, with outcomes reported as adjusted odds ratios (aORs) and 95% confidence intervals (CIs) . Results: We identified 903,230 adult patients hospitalized with acute PE, among whom 4,860 (0.54%) had a PFO. Patients with concomitant PE and PFO were younger (59.4 ± 15.9 vs. 63 ± 16.5 years, P < 0.001) and presented with more severe clinical features, including higher rates of saddle PE (17.7% vs. 9%, P < 0.001) and cor pulmonale (17.9% vs. 8.3%, P < 0.001) . They required significantly more frequent interventions, such as catheter-directed thrombolysis (7.4% Manuscript submitted August 11, 2025, accepted October 31, 2025 Published online December 20, 2025 aDepartment of Cardiovascular Medicine, Corewell Health William Beaumont University Hospital, Royal Oak, MI, USA bDepartment of Cardiology, Creighton University School of Medicine, Phoenix, AZ, USA cDivision of Cardiovascular Medicine, Department of Internal Medicine, Henry Ford Hospital, Detroit, MI, USA dDepartment of Internal Medicine, The Wright Center for Graduate Medical Education, Scranton, PA, USA eDepartment of Cardiovascular Medicine, Heart and Vascular Center, Case Western Reserve University/Metrohealth Medical Center, Cleveland, OH, USAfDepartment of Cardiovascular Medicine, Michigan State University College of Human Medicine, East Lansing, MI, USA gCorresponding Author: Vikas Aggarwal, Division of Cardiovascular Medicine, Department of Internal Medicine, Henry Ford Hospital, Detroit, MI, [USA. Email: vaggarw2@hfhs.org](USA. Email: vaggarw2@hfhs.org) doi: [https://doi.org/10.14740/cr2130](https://doi.org/10.14740/cr2130) vs. 3.8%, P < 0.001) . After multivariable adjustment, PFO presence was associated with significantly increased odds of stroke (aOR 25.5, 95% CI 19.8-32.8; P < 0.001) and peripheral embolism (aOR 13.7, 95% CI 10.5-18.0; P < 0.001) but not increased in-hospital mortality (aOR 0.9, 95% CI 0.6-1.3; P = 0.702) . Conclusion: In this nationwide study, PFO in patients with acute PE was linked to greater clinical severity and more frequent advanced interventions. Prospective studies are needed to define optimal screening strategies. Keywords: Pulmonary embolism; Patent foramen ovale; Stroke; Paradoxical embolism Introduction Pulmonary embolism (PE) is a significant cardiovascular condition associated with high morbidity, mortality, and substantial healthcare utilization [1, 2] . It represents the third most common cause of cardiovascular-related deaths, affecting hundreds of thousands of patients annually in the United States [1] . In addition to acute complications such as hemodynamic instability and death, PE can lead to long-term consequences, including chronic thromboembolic pulmonary hypertension (CTEPH) and recurrent thromboembolic events [3, 4] . Notably, a patent foramen ovale (PFO) - a persistent, conge

FAQs

How did the study define and compare patients with acute pulmonary embolism with and without PFO?

Adults hospitalized with acute PE from 2016 to 2020 were identified in the National Inpatient Sample using ICD-10 codes. Patients were grouped according to whether they had concomitant PFO, and clinical characteristics, advanced therapies, and in-hospital outcomes were compared.

What were the key findings regarding clinical severity in patients with PFO?

Patients with concomitant PE and PFO were younger and showed more severe features, including higher rates of saddle PE and cor pulmonale, and they required more frequent interventions such as catheter-directed thrombolysis.

Did PFO presence increase in-hospital mortality in this analysis?

No. After multivariable adjustment, PFO presence was associated with increased adjusted odds of stroke and peripheral embolism, but it was not associated with higher in-hospital mortality (aOR 0.9; P = 0.702).

What does the study conclude about future research needs?

PFO in acute PE was linked to greater clinical severity and more frequent advanced interventions. Prospective studies are needed to define optimal screening strategies.

Sep 28, 2026

Uploaded by Bulrr