Data on the epidemiological burden of acute pulmonary embolism (PE) in Switzerland is not available; furthermore, no analysis focused on the differences in incidence and case fatality rate depending on the presence/absence of acute right heart strain.

We did a nationwide, patient-level analysis of the Swiss Medical statistic including all patients aged 15 years or older hospitalized for acute PE in Switzerland from 2003 to 2022. Additionally, we analyzed the Swiss death registry for the same period. PE was defined by the ICD-10 codes I26 and O88.2, PE with acute right heart strain was defined by the ICD-10 code I26.0, PE without right heart strain by the code I26.9. We analyzed key epidemiological identifiers (incidence rate, mortality rate, case fatality rate, proportional mortality rate) of acute PE in Switzerland. Moreover, the incidence rate and case fatality rate were stratified by the presence/absence of acute right heart strain.

PE was recorded in 180,600 (51.4%) discharge certificates of patients hospitalized between 2003-2022. A total of 32,126 deaths were related to acute PE. In 2003, 9.9% of certificates mentioned acute right heart strain this proportion increased to 19.3% in 2022. The standardized incidence rate of PE increased from 0.9 cases per 1,000 population in 2003 to 1.2 cases per 1,000 population in 2022. In the overall cohort, the case fatality rate decreased from 9.8% in 2003 to 7.9% in 2019 subsequently peaking after the COVID-19 outbreak. The mortality rate and the proportional mortality rate both decreased over time. Over time, the age-standardized incidence rate of acute PE with acute right heart strain showed a progressively increasing trend in men and women; Figure 1. The case fatality rate was approximately three-time higher in patients with (vs. without) acute right heart strain and dropped from 20.1% in 2003 to 13.1% in 2022; Figure 2.

We presented an overview of the epidemiology of PE in Switzerland. Overall, the incidence rate showed an increasing trend, accompanied by a decreasing mortality rate and case fatality rate. All these trends were more evident among patients with pulmonary embolism and right heart strain.