Characteristics and Management of Patients Following Pulmonary Embolism: A Focus on Screening for Chronic Thromboembolic Pulmonary Hypertension

Abstract

Purpose Chronic thromboembolic pulmonary hypertension (CTEPH) can develop in 1 out of 25 (4%) patients following an acute pulmonary embolism (PE). It is recommended that high risk patients on anticoagulants, who have persistent shortness of breath post-PE, should be screened for CTEPH. Ventilation-perfusion scan is considered a gold standard tool for screening for CTEPH. This retrospective study sought to describe the use of CTEPH-related diagnostic and medical procedures post-PE in the United States. Methods Adult patients newly diagnosed with acute PE (index date) without prior pulmonary hypertension (PH) were identified from a large US administrative healthcare claims database (01/2007-03/2018; > 150 million patients). Patients were required to be continuously enrolled in their healthcare plan for ≥12 months pre-index (i.e., baseline period) and post-index (i.e., observation period). CTEPH-related diagnoses, procedures, and surgeries were evaluated during the observation period. Results A total of 93,947 patients with acute PE were identified. Mean age was 65.4 years and 54.4% were females. Over an average follow-up of 3.3 years post-index, 75.3% of patients were seen for ‘shortness of breath’, of whom 93.6% had an electrocardiogram, 75.2% an echocardiography, and 57.4% a computed tomographic angiography. Specific to CTEPH screening, 18.0% had a ventilation-perfusion scan, 7.6% a pulmonary angiogram, 4.7% a right heart catheterization. Among the 93,947 patients, 14,510 (15.4%) had a diagnosis of PH documented after acute PE, and 284 (0.3%) had a CTEPH-related procedure (i.e., pulmonary endarterectomy [0.2%; n=193] or balloon pulmonary angioplasty [0.1%; n=97]). Conclusion Real-world evidence shows that patients are not systematically monitored for CTEPH using diagnostic procedures recommended by current guidelines which state. “it is recommended that high risk patients on anticoagulants, who have persistent shortness of breath post-PE, should be screened for CTEPH”. There is an ongoing need to better define the use of CTEPH diagnostic procedures in patients who have experienced acute PE as well as risk prediction tools to identify patients at high risk of developing CTEPH after PE.