A new Spotlight Issue of JACC centers on the Guideline For the Evaluation and Management of Acute Pulmonary Embolism in Adults, released by the ACC and AHA earlier this year. The special issue highlights key guideline recommendations for acute pulmonary embolism (PE) through a patient-centered journey – from risk factors to long-term management, while also identifying areas for future clarification and updates.

"With enduring risk factors such as cancer and obesity on the rise and the expanding role of cardiovascular medicine specialists, this evidence-based guideline is timely in shaping multidisciplinary care," write JACC Editor-in-Chief Harlan M. Krumholz, MD, SM, MACC, and colleagues in an accompanying editor's note. "Although the title is framed around acute PE, the text rightly underscores that the impact of PE extends beyond the initial event. Longitudinal management has become essential to optimize patient outcomes and reduce the long-term burden of this complex disease."

Issue highlights include:

• A brief report by Mushood Ahmed, MBBS, et al., analyzing Pulmonary Embolism-Attributed Hospitalization and Mortality in the United States. Using national hospitalization and mortality data from 2016-2023, Ahmed and colleagues found that PE-attributable mortality increased in the U.S. However, reported hospitalization rates were stable and included a decline during 2020, suggesting under-detection and under-reporting of PE events. They stress the need for "robust, reliable national surveillance systems to accurately monitor PE trends to inform public policy."
• In another brief report looking at "Trends in 90-Day Mortality, Recurrent Venous Thrombosis, and Bleeding in Patients With Pulmonary Embolism," JACC Executive Associate Editor Behnood Bikdeli, MD, FACC, and colleagues analyzed 31,154 PE patients from the international RIETE registry and found no major change in all-cause or PE-related mortality or major bleeding between 2016 and 2024. "With widespread use of computed tomography and increase in the number of patients with smaller emboli, it is likely that most treated patients are not at high risk of death or other complications, making it less likely to see a major population-level change in trends," write the authors.
• In Temporal Trends in Bleeding and Mortality in High-Risk Pulmonary Embolism, Rachel P. Rosovsky, MD, MPH, et al., leveraged data from the PERT Consortium Quality Assurance Database, to examine whether mortality and bleeding outcomes in 1,997 high-risk patients with PE treated by Pulmonary Embolism Response Teams (PERTs) changed between 2018-2024. Overall results found major bleeding decreased over time, while mortality remained unchanged. "The reduction in bleeding over successive years aligns with evolving PE treatment patterns, including decreased use of systemic thrombolysis and increased adoption of [catheter-directed thrombectomy]," said the investigators. "Improvement in PE care systems, patient selection, operator experience, anticoagulation stewardship, guideline-directed monitoring, earlier diagnosis, and supportive care may have also contributed."
• A commentary by Gregory Piazza, MD, FACC, and Mary Cushman, MD, MSC, addresses the new AHA/ACC Acute Pulmonary Embolism Clinical Categories, calling them "a versatile tool for the next generation of clinicians, investigators, and most importantly, patients." As the needs of clinicians and researchers have grown, "the Clinical Categories acknowledge these needs as well as the current unprecedented period of technological innovation and scientific investigation," they write.
• In their commentary, A Field in Transition Catheter-Based Therapy in the 2026 AHA/ACC Acute Pulmonary Embolism Guideline, Mark A. Creager, MD, FACC; Geoffrey D. Barnes, MD, MSc, FACC; and Jay S. Giri, MD, discuss how the PE Guideline approaches catheter-based therapies such as catheter-directed thrombolysis and mechanical thrombectomy. "We possess powerful tools that undeniably improve acute hemodynamics and imaging endpoints, yet we lack the definitive data to prove they improve patient lives," they write, pointing to ongoing randomized trials (including HI-PEITHO) that may clarify the role of these therapies and inform future updates. Reflecting this uncertainty, the current Guideline recommendations "validate the use of advanced catheter-based therapies in the sickest patients, while demanding better evidence before endorsing widespread adoption in more stable cohorts."
• Living After Pulmonary Embolism is the focus of a commentary by Francisco Ujueta, MD, BS, MS, FACC, and Aaron W. Aday, MD. They highlight the often-overlooked long-term recovery period after acute PE, emphasizing emotional, social and functional outcomes. "Future initiatives should aim to formalize post-PE rehabilitation frameworks to include supervised exercise programs, education, and psychological support, anchoring emotional recovery as an essential component of PE survivorship," they write.

Visit JACC's Acute Pulmonary Embolism Guideline Hub to read the full Guideline, its accompanying Guideline-at-a-Glance summary and other clinical resources. Plus, download ACC's Guideline Clinical App to access the document anytime, anywhere – for easy reference in your practice.

Clinical Topics: Vascular Medicine, Invasive Cardiovascular Angiography and Intervention

Keywords: Venous Thrombosis, Pulmonary Embolism, Cardiovascular Critical Care, Care Team, Patient Care Team