Effect of pulmonary embolism response team on advanced therapies administered: The University of Michigan experience

Ardeshna, Nelish; Song, Melinda R.; Hyder, Syed N.; Grace, K.A.; O'Hare, Connor; Schaeffer, William J.; Stover, Michael D.; Greineder, Colin F.; Barnes, Geoffrey D.

doi:10.1016/j.thromres.2022.11.017

Cited by 11 publications

(3 citation statements)

References 22 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Since PERT is implemented in several countries and hospitals, the overuse of invasive techniques was a main matter of concern [ 4 ]. Several single-center studies from the United States found no significant reduction in mortality, but at the same time a trend toward more intensified therapies [ 19 – 21 ]. This was not the case in our cohort, more patients in the pre-PERT era received advanced reperfusion therapies as systemic full-dose thrombolysis or surgical embolectomy than patients in the PERT era, which could potentially explain the higher rate of bleeding complications in the pre-PERT era.…”

Section: Discussionmentioning

confidence: 99%

A multidisciplinary pulmonary embolism response team (PERT): first experience from a single center in Germany

Sagoschen,

Scibior,

Farmakis

et al. 2023

Clin Res Cardiol

View full text Add to dashboard Cite

Background Over the last few years, the concept of multidisciplinary pulmonary embolism response teams (PERTs) has emerged to encounter the increasing variety and complexity in managing acute pulmonary embolism (PE). Purpose To investigate PERT's composition and added clinical value in a university center in Germany. Methods Over 4 years (01/2019–11/2022), patients with confirmed PE were enrolled in a prospective single-center cohort study (PERT Mainz). We investigated the composition of PERT and compared, after propensity score matching, patients with acute PE before and after the initiation of PERT at our Medical University Centre. The primary outcome was in-hospital PE-related mortality. Results From 2019 to 2022, 88 patients with acute PE with a PERT decision were registered. Of those, 13 (14.8%) patients died during the in-hospital stay. Patients evaluated by a PERT had a median age of 68; 48.9% were females, and 21.7% suffered from malignancy. Right ventricular dysfunction was present in 76.1% of all patients. In total, 42.0% were classified as intermediate–high-risk PE and 11.4% as high-risk PE. First PERT contact mainly originated from emergency departments (33.3%) and intensive care units (30.0%), followed by chest pain units (21.3%) and regular wards (12.0%). The participation rate of medical specialties demonstrated that cardiologists (100%) or cardiac/vascular surgeons (98.6%) were included in almost all PERT consultations, followed by radiologists (95.9%) and anesthesiologists (87.8%). Compared to the PERT era, more patients in the pre-PERT era were classified as simplified pulmonary embolism severity index (sPESI) ≥ 1 (78.4% vs 71.6%) and as high-risk PE according to ESC 2019 guidelines (18.2% vs. 11.4%). In the pre-PERT era, low- and intermediate-low patients with PE received more frequently advanced reperfusion therapies such as systemic thrombolysis or surgical embolectomy compared to the PERT era (10.7% vs. 2.5%). Patients in the pre-PERT were found to have a considerably higher all-cause mortality and PE-related mortality rate (31.8% vs. 14.8%) compared to patients in the PERT era (22.7% vs. 13.6%). After propensity matching (1:1) by including parameters as age, sex, sPESI, and ESC risk classes, univariate regression analyses demonstrated that the PE management based on a PERT decision was associated with lower risk of all-cause mortality (OR, 0.37 [95%CI 0.18–0.77]; p = 0.009). For PE-related mortality, a tendency for reduction was observed (OR, 0.54 [95%CI 0.24–1.18]; p = 0.121). Conclusion PERT implementation was associated with a lower risk of all-cause mortality rate in patients with acute PE. Large prospective studies are needed further to explore the impact of PERTs on clinical outcomes. Graphical abstract

show abstract

Section: Discussionmentioning

confidence: 99%

A multidisciplinary pulmonary embolism response team (PERT): first experience from a single center in Germany

Sagoschen,

Scibior,

Farmakis

et al. 2023

Clin Res Cardiol

View full text Add to dashboard Cite

show abstract

“…Construction of the database, including manual review of each chart by two independent physicians, has been described in detail elsewhere. 15 16 Briefly, acute PE patients were identified from encounters in which computed tomography pulmonary angiography (CTPA) was ordered during or just prior to ED evaluation. Manual chart review by two physicians excluded cases in which PE was not acute, not diagnosed during ED evaluation, or not deemed to be clinically significant.…”

Section: Methodsmentioning

confidence: 99%

Optimizing Use of High-Sensitivity Troponin for Risk-Stratification of Acute Pulmonary Embolism

Goraya,

O'Hare,

Grace

et al. 2024

Thromb Haemost

Self Cite

View full text Add to dashboard Cite

Background High-sensitivity troponin T (HS-TnT) may improve risk-stratification in hemodynamically stable acute pulmonary embolism (PE), but an optimal strategy for combining this biomarker with clinical risk-stratification tools has not been determined. Study Hypothesis We hypothesized that different HS-TnT cutoff values may be optimal for identifying (1) low-risk patients who may be eligible for outpatient management and (2) patients at increased risk of clinical deterioration who might benefit from advanced PE therapies. Methods Retrospective analysis of hemodynamically stable patients in the University of Michigan acute ED-PE registry with available HS-TnT values. Primary and secondary outcomes were 30-day mortality and need for intensive care unit-level care. Receiver operating characteristic curves were used to determine optimal HS-TnT cutoffs in the entire cohort, and for those at higher risk based on the simplified Pulmonary Embolism Severity Index (PESI) or imaging findings. Results The optimal HS-TnT cutoff in the full cohort, 12 pg/mL, was significantly associated with 30-day mortality (odds ratio [OR]: 3.94, 95% confidence interval [CI]: 1.48–10.50) and remained a significant predictor after adjusting for the simplified PESI (sPESI) score and serum creatinine (adjusted OR: 3.05, 95% CI: 1.11–8.38). A HS-TnT cutoff of 87 pg/mL was associated with 30-day mortality (OR: 5.01, 95% CI: 2.08–12.06) in patients with sPESI ≥1 or right ventricular dysfunction. Conclusion In this retrospective, single-center study of acute PE patients, we identified distinct optimal HS-TnT values for different clinical uses—a lower cutoff, which identified low-risk patients even in the absence of other risk-stratification methods, and a higher cutoff, which was strongly associated with adverse outcomes in patients at increased risk.

show abstract

“…In fact, there have been reports that PERT may be associated with a decrease in advanced therapies administered to acute PE patients without an impact on clinical outcomes. 55 However, prospective and randomized clinical studies are still lacking to firmly establish the notion that PERT may lead to a more prudent and targeted use of advanced therapy and improve outcomes in patients with higher risk of PE.…”

Section: Pert and Use Of Advanced Treatment Optionsmentioning

confidence: 99%

The Current Evidence of Pulmonary Embolism Response Teams and Their Role in Future

Hobohm,

Farmakis,

Duerschmied

et al. 2024

Hamostaseologie

View full text Add to dashboard Cite

Acute pulmonary embolism (PE) remains a critical medical condition requiring prompt and accurate management. The introduction and growing significance of pulmonary embolism response teams (PERT), also termed EXPERT-PE teams, signify a paradigm shift toward a collaborative, multidisciplinary approach in managing this complex entity. As the understanding of acute PE continues to evolve, PERTs stand as a linkage of optimized care, offering personalized and evidence-based management strategies for patients afflicted by this life-threatening condition. The evolving role of PERTs globally is evident in their increasing integration into the standard care pathways for acute PE. These teams have demonstrated benefits such as reducing time to diagnosis and treatment initiation, optimizing resource utilization, and improving patient outcomes.

show abstract

Effect of pulmonary embolism response team on advanced therapies administered: The University of Michigan experience

Cited by 11 publications

References 22 publications

A multidisciplinary pulmonary embolism response team (PERT): first experience from a single center in Germany

A multidisciplinary pulmonary embolism response team (PERT): first experience from a single center in Germany

Optimizing Use of High-Sensitivity Troponin for Risk-Stratification of Acute Pulmonary Embolism

The Current Evidence of Pulmonary Embolism Response Teams and Their Role in Future

Contact Info

Product

Resources

About