Abstract
BackgroundAcute pulmonary embolism remains a significant cause of mortality and morbidity worldwide. Benefit of recently developed multidisciplinary PE response teams (PERT) with higher utilization of advanced therapies has not been established.MethodsTo evaluate patient-centered outcomes and cost-effectiveness of a multidisciplinary PERT we performed a retrospective analysis of 554 patients with acute PE at the university of Virginia between July 2014 and June 2015 (pre-PERT era) and between April 2017 through October 2018 (PERT era). Six-month survival, hospital length-of-stay (LOS), type of PE therapy, and in-hospital bleeding were assessed upon collected data.Results317 consecutive patients were treated for acute PE during an 18-month period following institution of a multidisciplinary PE program; for 120 patients PERT was activated (PA), the remaining 197 patients with acute PE were considered as a separate, contemporary group (NPA). The historical, comparator cohort (PP) was composed of 237 patients. These 3 groups were similar in terms of baseline demographics, comorbidities and risk, as assessed by the Pulmonary Embolism Severity Index (PESI). Patients in the historical cohort demonstrated worsened survival when compared with patients treated during the PERT era. During the PERT era no statistically significant difference in survival was observed in the PA group when compared to the NPA group despite significantly higher severity of illness among PA patients. Hospital LOS was not different in the PA group when compared to either the NPA or PP group. Hospital costs did not differ among the 3 cohorts. 30-day re-admission rates were significantly lower during the PERT era. Rates of advanced therapies were significantly higher during the PERT era (9.1% vs. 2%) and were concentrated in the PA group (21.7% vs. 1.5%) without any significant rise in in-hospital bleeding complications.ConclusionsAt our institution, all-cause mortality in patients with acute PE has significantly and durably decreased with the adoption of a PERT program without incurring additional hospital costs or protracting hospital LOS. Our data suggest that the adoption of a multidisciplinary approach at some institutions may provide benefit to select patients with acute PE.
Highlights
Acute pulmonary embolism remains a significant cause of mortality and morbidity worldwide
Our data suggest that the adoption of a multidisciplinary approach at some institutions may provide benefit to select patients with acute pulmonary embolism (PE)
This trend was most recently acknowledged by the 2019 European Society of Cardiology (ESC) guidelines, which published a class IIA recommendation promoting institutional establishment of PE response teams (PERT) for the purpose of managing high-risk and selected cases of intermediate-risk PE, a recommendation based on the lowest level of evidence (C) [3]
Summary
Acute pulmonary embolism remains a significant cause of mortality and morbidity worldwide. Prompted in part by the lack of clear guidelines surrounding the use of these emerging, advanced treatment modalities, the adoption of a multidisciplinary approach to management of acute PE has increased in popularity across academic centers. Such teams have been assembled as a reasonable response to address often complex clinical situations and varying institutional experiences with these therapies. The rapid nationwide growth of these teams has been catalyzed by the recent formation of the National PERT consortium This trend was most recently acknowledged by the 2019 European Society of Cardiology (ESC) guidelines, which published a class IIA recommendation promoting institutional establishment of PERTs for the purpose of managing high-risk and selected cases of intermediate-risk PE, a recommendation based on the lowest level of evidence (C) [3]
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