Management appropriateness and outcomes of patients with acute pulmonary embolism

Abstract

The impact of adherence to published guidelines on the outcomes of patients with acute pulmonary embolism (PE) has not been well defined by previous studies.In this prospective cohort study of patients admitted to a respiratory department (n=2096), we evaluated whether patients with PE had better outcomes if they were acutely managed according to international guidelines. Outcomes consisted of all-cause mortality, PE-related mortality, recurrent venous thromboembolism (VTE) and major bleeding events during the first month of follow-up after diagnosis.Overall, 408 patients (19% (95% CI 18-21%)) did not receive guideline-adherent PE management. Patients receiving non-adherent management were significantly more likely to experience all-cause mortality (adjusted odds ratio (OR) 2.39 (95% CI 1.57-3.61) or PE-related mortality (adjusted OR 5.02 (95% CI 2.42-10.42); p<0.001) during follow-up. Non-adherent management was also a significant independent predictor of recurrent VTE (OR 2.19 (95% CI 1.11-4.32); p=0.03) and major bleeding (OR 2.65 (95% CI 1.66-4.24); p<0.001). An external validation cohort of 34 380 patients with PE from the RIETE registry confirmed these findings.PE management that does not adhere to guidelines for indications related to anticoagulation, thrombolytics and inferior vena cava filters is associated with worse patient outcomes.

Hospital volume and outcomes for acute pulmonary embolism: multinational population based cohort study

“…In fact, our study showed that clinicians at low volume hospitals adhered to evidence based guidelines less frequently, which has been shown to correlate with patient outcomes. 21 …”

2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS)

“…Time trend analyses in European, Asian, and North American populations suggest that case fatality rates of acute PE may be decreasing [4-7, 10, 11]. Increased use of more effective therapies and interventions, and possibly better adherence to guidelines [12,13], has most likely exerted a significant positive effect on the prognosis of PE in recent years. However, there is also a tendency towards overdiagnosis of (subsegmental or even non-existent) PE in the modern era [14], and this might in turn lead to a false drop in case fatality rates by inflating the denominator, i.e.…”

“…The most frequently cited risk factors and predisposing conditions for CTEPH are shown in table 13. In an international registry, a history of acute PE was reported by 75% of patients [447].…”

Developing a scoring tool to estimate the risk of deterioration for normotensive patients with acute pulmonary embolism on admission

“…In this context, elevated NT-pro BNP and c-Tn I concentrations are caused by myocyte stretching [27]. However, NT-pro BNP can re ect the patient's current state and also underlying disease, such as chronic heart failure [28,30], although c-Tn I concentrations do not. This difference may explain why NT-pro BNP concentrations but not c-Tn I concentrations were signi cantly associated with adverse outcomes in our tool.…”