Current practice patterns of outpatient management of acute pulmonary embolism: A post-hoc analysis of the YEARS study
Background: Studies have shown the safety of home treatment of patients with pulmonary embolism (PE) at low risk of adverse events. Management studies focusing on home treatment have suggested that 30% to 55% of acute PE patients could be treated at home, based on the HESTIA criteria, but data from day-to-day clinical practice are largely unavailable. Aim: To determine current practice patterns of home treatment of acute PE in the Netherlands. Method: We performed a post-hoc analysis of the YEARS study. The main outcomes were the proportion of patients who were discharged <24 h and reasons for admission if treated in hospital. Further, we compared the 3-month incidence of PE-related unscheduled readmissions between patients treated at home and in hospital. Results: Of the 404 outpatients with PE included in this post-hoc analysis of the YEARS study, 184 (46%) were treated at home. The median duration of admission of the hospitalized patients was 3.0 days. The rate of PE-related readmissions of patients treated at home was 9.7% versus 8.6% for hospitalized patients (crude hazard ratio 1.1 (95% CI 0.57–2.1)). The 3-month incidence of any adverse event was 3.8% in those treated at home (2 recurrent VTE, 3 major bleedings and two deaths) compared to 10% in the hospitalized patients (3 recurrent VTE, 6 major bleedings and fourteen deaths). Conclusions: In the YEARS study, 46% of patients with PE were treated at home with low incidence of adverse events. PE-related readmission rates were not different between patients treated at home or in hospital.
|Keywords||Acute pulmonary embolism, Ambulatory care, Daily practice, Outpatients, Readmissions|
|Persistent URL||dx.doi.org/10.1016/j.thromres.2020.05.038, hdl.handle.net/1765/127754|
|Journal||Thrombosis Research: vascular obstruction, hemorrhage and hemostasis|
Hendriks, S.V. (Stephan V.), Bavalia, R. (Roisin), van Bemmel, T, Bistervels, I.M. (Ingrid M.), Eijsvogel, M, Faber, L.M, … Klok, F.A. (2020). Current practice patterns of outpatient management of acute pulmonary embolism: A post-hoc analysis of the YEARS study. Thrombosis Research: vascular obstruction, hemorrhage and hemostasis, 193, 60–65. doi:10.1016/j.thromres.2020.05.038