Pulmonary embolism, or PE, is a serious and sometimes life-threatening condition that occurs when a blood clot travels to the lungs and blocks blood flow. Despite advances in diagnosis and treatment, PE continues to place a significant burden on patients and health systems worldwide; at least 400,000 hospitalizations in the US are annually as a result of or complicated by PE.
Much of the care for PE relates to cardiovascular specialists these days, from echocardiography or use of biomarkers that have a home in cardiology (troponin and NT-proBNP) to the recently emerged catheter-based advances to reduce the burden of thrombi and relieve the extra pressure on the right 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.
Gregory Piazza, MD, MS, Rachel Rosovsky, MD, MPH, and the late Ido Weinberg, MD of Mass General Brigham were among the Writing Committee members and Behnood Bikdeli, MD, MS was in the Peer Review Committee of the guideline. To honor this very first guideline from major cardiovascular societies and to raise awareness about PE, the Journal of the American College of Cardiology (JACC) dedicated an entire issue in April to PE and the new PE guideline.
In this Q&A, Behnood Bikdeli, MD, MS, of the Heart and Vascular Institute at Mass General Brigham 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 this upcoming special edition of JACC ?
For the first time, the American Heart Association and the American College of Cardiology released a dedicated clinical guideline focused entirely on pulmonary embolism, or PE. 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. Krumholz, Dr. 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 makes the 2026 AHA/ACC guidelines for acute pulmonary embolism significant?
These are the first formal AHA/ACC guidelines focused specifically on pulmonary embolism. PE occurs when a blood clot, most often from the leg, travels to the lungs and blocks blood flow. This can reduce oxygen levels in the body and place dangerous strain on the heart, making PE potentially life threatening.
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 guideline 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.
Can you tell us more about the global study on trends in 90-day outcomes after pulmonary embolism?
In this study, my team and I examined 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.
What did the study find?
The study shows 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 1 in 5 may die from PE even despite state-of-the-art therapies.
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 a noticeable increase during 2020 and 2021 that coincided with the COVID-19 pandemic. PE-attributable mortality , analyzed using the CDC data, showed a gradual increase over time but also an unexpected decline in 2020, 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 also, they unraveled issues with current tools available to us for surveillance, which have important limitations and tendencies for error. In fact, we just got funded by the AHA to improve the accuracy of surveillance through large databases and have other major applications ongoing to address these issues. We really can’t have good strategies to prevent and treat PE at scale unless we can accurately estimate epidemiological features.
Any final remarks about the PE Spotlight issue?
Pulmonary embolism is one of the most common diagnoses encountered on medical rounds. Data presented in this JACC Spotlight issue and related work show that PE is 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 policy makers remain unaware of this burden, and clinicians may not always be up to date on optimal diagnosis, acute management, or follow‑up care.
Journal of the American College of Cardiology
People
7-Apr-2026