Current practice patterns of outpatient management of acute pulmonary embolism: A post-hoc analysis of the YEARS study. Issue 193 (September 2020)

• Record Type: Journal Article
• Authors: Hendriks, Stephan V.; Bavalia, Roisin; van Bemmel, Thomas; Bistervels, Ingrid M.; Eijsvogel, Michiel; Faber, Laura M.; Fogteloo, Jaap; Hofstee, Herman M.A.; van der Hulle, Tom; Iglesias del Sol, Antonio; Kruip, Marieke J.H.A.; Mairuhu, Albert T.A.; Middeldorp, Saskia; Nijkeuter, Mathilde; Huisman, Menno V.; Klok, Frederikus A.
• Is Part Of: Thrombosis research. Issue 193(2020)
• Page Start: 60
• Page End: 65
• Publication Date: 2020-09
• Subjects: Acute pulmonary embolism -- Ambulatory care -- Outpatients -- Readmissions -- Daily practice; Thrombosis -- Periodicals; 616.135
• DOI: 10.1016/j.thromres.2020.05.038
• Languages: English
• ISSNs: 0049-3848

Abstract

Abstract: 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. Highlights: Several studies have shown the safety and feasibility of home treatment in pulmonary embolism (PE) patients. Detailed information of home treatment in daily clinical practice is largely unavailable. 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.