Comprehensive management of acute pulmonary embolism in primary care using telemedicine in the COVID-era

Abstract

A healthy, active woman in her 70s reported intermittent exertional dyspnoea for 2 months, notable during frequent open-water swimming. Symptoms were similar to an episode of travel-provoked pulmonary embolism 3 years prior. She denied chest pain, cough, fever, extremity complaints and symptoms at rest. Due to the COVID-19 pandemic, her healthcare system was using secure telemedicine to evaluate non-critical complaints. During the initial video visit, she appeared well, conversing normally without laboured breathing. An elevated serum D-dimer prompted CT pulmonary angiography, which identified acute lobar pulmonary embolism. After haematology consultation and telephone conversation with the patient, her physician prescribed rivaroxaban. Her symptoms rapidly improved. She had an uneventful course and is continuing anticoagulation indefinitely. The pandemic has increased the application of telemedicine for acute care complaints. This case illustrates its safe and effective use for comprehensive management of acute pulmonary embolism in the primary care setting.

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“…Moreover, after COVID-19 pandemic, there is a trend to implement telemedicine as an expanding and feasible approach to improve medical care for patients with chronic diseases. 24–26 These advances have the potential to support patients with long-term diseases to manage their health at home, leading a remote healthcare more accessible and efficient. 26 Two earlier studies found usefulness of phone-based patients follow-up, 8 16 although our work analysed the impact of this strategy comparing patients diagnosed of CTEPH before and after applying the protocol.…”

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“…Additionally, as stated above, published literature indicates that insurance is only one contributor to life expectancymany economic, lifestyle, and social factors also influence life expectancy outcomes. 22,[39][40][41][42][43] Furthermore, many of these factors influence insurance status. Thus, members of KPMAS examined in this study were likely to benefit from other socioeconomic and lifestyle advantages that could improve their life expectancy.…”

“…The research team met weekly during data analysis to develop the codebook and review emergent themes. Research team members who conducted the interviews discussed codes and themes to reach consensus on code meanings and domains, [42][43][44] co-creating the structure of the analysis and establishing trustworthiness. 45 The finalized codebook was then used to code all transcripts.…”

“…32,38 More recently, attention has turned to the management of patients diagnosed with acute PE in primary care. [39][40][41][42][43] Our patient was low risk on the PE Severity Index (score 47 points, Class I), lacked all the Hestia criteria that might warrant inpatient management, and met the CHEST criteria for outpatient management. 3,4 By these several indicators, she was eligible for outpatient care, even if she had been discharged with anticoagulation.…”

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“…Telemedicine has also become a key tool for screening potentially early symptoms of Sars-Cov-2, protecting both the patients and medical personnel from additional contamination exposure (Hollander and Carr, 2020;Perrin et al, 2020). Many scholars have recently reported a revolution of telemedicine in various healthcare areas, including, inter alia, in pulmonology and primary care (Chang et al, 2021); oncology (Hasson et al, 2021), otolaryngology (Ohlstein et al, 2020).…”