Publication date: Jul 26, 2024

Pulmonary embolism (PE) is a well-recognised complication of COVID-19 infection, and chronic thromboembolic pulmonary disease with and without pulmonary hypertension (CTEPD/CTEPH) are potential life-limiting consequences. At present the burden of CTEPD/CTEPH is unclear and optimal and cost-effective screening strategies yet to be established. We evaluated the CTEPD/CTEPH referral rate to the UK national multidisciplinary team (MDT) during the 2017-2022 period to establish the national incidence of CTEPD/CTEPH potentially attributable to COVID-19-associated PE with historical comparator years. All individual cases of suspected CTEPH were reviewed by the MDT for evidence of associated COVID-19. In a separate multicentre cohort, the risk of developing CTEPH following hospitalisation with COVID-19 was calculated using simple clinical parameters at a median of 5 months post hospital discharge according to existing risk scores using symptoms, ECG and NT pro-BNP. By the second year of the pandemic, CTEPH diagnoses had returned to the pre-pandemic baseline (23. 1 versus 27. 8 cases per month, p=0. 252). Of 334 confirmed CTEPD/CTEPH cases, 4 (1. 2%) patients were identified to have CTEPH potentially associated with COVID-19 PE, and a further 3 (0. 9%) CTEPD without PH. Of 1094 patients (mean age 58 years, 60. 4% male) hospitalised with COVID-19 screened across the UK, 11 (1. 0%) were at high risk of CTEPH at follow-up, none of whom had a diagnosis of CTEPH made at the national MDT. A-priori risk of developing CTEPH following COVID-19-related hospitalisation is low. Simple risk scoring is a potentially effective way of screening patients for further investigation.

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