Home treatment of acute pulmonary embolism

Wall, Sake J van der; Hendriks, Stephan V; Huisman, Menno V.; Klok, Frederikus A.

doi:10.1097/mcp.0000000000000512

Cited by 18 publications

(14 citation statements)

References 29 publications

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“…The majority of patients with acute PE are nowadays still treated in hospital. 2,[5][6][7][8][9][10] According to the 2019 ESC guidelines, hospitalization is recommended for all patients with intermediate-risk PE. 1 In the Hestia and Vesta studies, RV function evaluation (which is critical to the risk stratification as recommended by the ESC) was not part of standard baseline assessment.…”

Section: Discussionmentioning

confidence: 99%

“…Notably and in contrast, the Hestia clinical decision rule, which consists of objective parameters of risk of mortality such as shock or hypoxemia, contains no explicit parameters of RV function. 2 Of all 11 score items, one however is subjective, that is, "medical or social reason for treatment in the hospital for more than 24 hours," allowing the treating physician to consider all patient-specific circumstances in the final management decision, including RV function. 3 It is unknown how often and why this subjective criterion of the Hestia criteria is scored and used as the main argument to hospitalize the patient.…”

Section: Introductionmentioning

confidence: 99%

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Reasons for Hospitalization of Patients with Acute Pulmonary Embolism Based on the Hestia Decision Rule

et al. 2020

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Background The Hestia criteria can be used to select pulmonary embolism (PE) patients for outpatient treatment. The subjective Hestia criterion “medical/social reason for admission” allows the treating physician to consider any patient-specific circumstances in the final management decision. It is unknown how often and why this criterion is scored. Methods This is a patient-level post hoc analysis of the combined Hestia and Vesta studies. The main outcomes were the frequency of all scored Hestia items in hospitalized patients and the explicit reason for scoring the subjective criterion. Hemodynamic parameters and computed tomography-assessed right ventricular (RV)/left ventricular (LV) ratio of those only awarded with the subjective criterion were compared with patients treated at home. Results From the 1,166 patients screened, data were available for all 600 who were hospitalized. Most were hospitalized to receive oxygen therapy (45%); 227 (38%) were only awarded with the subjective criterion, of whom 51 because of “intermediate to intermediate-high risk PE.” Compared with patients with intermediate risk PE (RV/LV ratio > 1.0) treated at home (179/566, 32%), hospitalized patients with only the subjective criterion had a higher mean RV/LV ratio (mean difference +0.30, 95% confidence interval [CI] 0.19–0.41) and a higher heart rate (+18/min, 95% CI 10–25). No relevant differences were observed for other hemodynamic parameters. Conclusion The most frequent reason for hospital admission was oxygen therapy. In the decision to award the subjective criterion as sole argument for admission, the severity of the RV overload and resulting hemodynamic response of the patient was taken into account rather than just abnormal RV/LV ratio.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Reasons for Hospitalization of Patients with Acute Pulmonary Embolism Based on the Hestia Decision Rule

et al. 2020

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“…2) [20], ermöglichen eine valide Prognoseabschätzung und haben ihren Stellenwert insbesondere bei der Identifikation von Patienten mit "niedrigem Risiko". Diese Patienten sind möglicherweise für eine frühe Entlassung und ambulante Therapie geeignet [14]. Durch Anwendung dieser klinischen Scores können etwa 25-30 % aller Patienten in eine Gruppe mit "niedrigem Risiko" eingeteilt werden.…”

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Lungenembolie

Hobohm¹,

Lankeit²

2021

Pneumologie

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“…7,8 For PE, there has been a change over the last decade, as the safety and feasibility of home treatment have been shown in several large trials. [9][10][11][12][13][14][15][16] With the recent introduction of direct oral anticoagulants (DOACs) that have a better safety profile than conventional anticoagulants, 17 the threshold to treat a PE patient at home has been further lowered. 18 A reduced length of stay and resultant decrease in total hospital costs in patients treated with a DOAC has already been demonstrated.…”

Section: Introductionmentioning

confidence: 99%

Home Treatment Compared to Initial Hospitalization in Normotensive Patients with Acute Pulmonary Embolism in the Netherlands: A Cost Analysis

et al. 2021

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Background: Venous thromboembolism constitutes substantial healthcare costs amounting to about 60 million euros per year in the Netherlands. Compared to initial hospitalization, home treatment of pulmonary embolism (PE) is associated with a cost reduction. An accurate estimation of cost savings per patient treated at home is currently lacking. Aim: The aim of this study was to compare healthcare utilization and costs during the first 3 months after a PE diagnosis in patients who are treated at home versus those who are initially hospitalized. Methods: Patient-level data of the YEARS cohort study was used to estimate the proportion of patients treated at home, mean hospitalization duration in those who were hospitalized and rates of PE-related readmissions and complications. To correct for baseline differences within the two groups, regression analyses was performed. The primary outcome was the average total healthcare costs during a 3-month follow-up period for patients initially treated at home or in hospital. Results: Mean hospitalization duration for the initial treatment was 0.69 days for those treated initially at home (n=181) and 4.3 days for those initially treated in hospital (n=202). Total average costs per hospitalized patient were €3.204 and €1.507 per patient treated at home. The adjusted mean difference was €1.483 (95%CI €1.181 – 1.784). Conclusions: Home treatment of hemodynamically stable patients with acute PE was associated with an estimated net cost reduction of €1.483 per patient. This difference underlines the advantage of triage-based home treatment of these patients.

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Home treatment of acute pulmonary embolism

Cited by 18 publications

References 29 publications

Reasons for Hospitalization of Patients with Acute Pulmonary Embolism Based on the Hestia Decision Rule

Reasons for Hospitalization of Patients with Acute Pulmonary Embolism Based on the Hestia Decision Rule

Lungenembolie

Home Treatment Compared to Initial Hospitalization in Normotensive Patients with Acute Pulmonary Embolism in the Netherlands: A Cost Analysis

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