Current practice patterns of outpatient management of acute pulmonary embolism: A post-hoc analysis of the YEARS study

Stephan V Hendriks,Roisin Bavalia,Thomas Van Bemmel,Ingrid M Bistervels,Michiel Eijsvogel,Laura M Faber,Jaap Fogteloo,Herman M.A Hofstee,Tom Van Der Hulle,Antonio Iglesias Del Sol,Marieke J.H.A Kruip,Albert T.A Mairuhu,Saskia Middeldorp,Mathilde Nijkeuter,Menno V Huisman,Frederikus A Klok

doi:10.1016/j.thromres.2020.05.038

Abstract

BackgroundStudies have shown the safety of home treatment of patients with pulmonary embolism (PE) at low risk of adverse events. Management studies focusing on home treatment have suggested that 30% to 55% of acute PE patients could be treated at home, based on the HESTIA criteria, but data from day-to-day clinical practice are largely unavailable. AimTo determine current practice patterns of home treatment of acute PE in the Netherlands. MethodWe performed a post-hoc analysis of the YEARS study. The main outcomes were the proportion of patients who were discharged <24 h and reasons for admission if treated in hospital. Further, we compared the 3-month incidence of PE-related unscheduled readmissions between patients treated at home and in hospital. ResultsOf the 404 outpatients with PE included in this post-hoc analysis of the YEARS study, 184 (46%) were treated at home. The median duration of admission of the hospitalized patients was 3.0 days. The rate of PE-related readmissions of patients treated at home was 9.7% versus 8.6% for hospitalized patients (crude hazard ratio 1.1 (95% CI 0.57–2.1)). The 3-month incidence of any adverse event was 3.8% in those treated at home (2 recurrent VTE, 3 major bleedings and two deaths) compared to 10% in the hospitalized patients (3 recurrent VTE, 6 major bleedings and fourteen deaths). ConclusionsIn the YEARS study, 46% of patients with PE were treated at home with low incidence of adverse events. PE-related readmission rates were not different between patients treated at home or in hospital.

Highlights

Over the last decade, there has been a trend towards treating patients with pulmonary embolism (PE) at low-risk of early adverse events at home
A total of 456 patients were diagnosed with acute PE in the YEARS study
The PE-associated unscheduled readmissions of patients initially hospitalized consisted of nine admissions, eight emergency room visits and two unscheduled visits to the outpatient clinic, whereas unscheduled PE-associated readmissions of patients treated at home consisted of nine admissions and nine emergency room visits. This post-hoc analysis of the YEARS study showed that 46% of all outpatients with confirmed PE were treated at home in Dutch daily clinical practice

Summary

Introduction

There has been a trend towards treating patients with pulmonary embolism (PE) at low-risk of early adverse events at home. The severity of the PE and risk of adverse outcomes largely determine clinical decision making with regard to initial home treatment. Other factors such as locoregional cultural and patient preferences, the (financing of the) healthcare system and corresponding infrastructure play a role. Studies have shown the safety of home treatment of patients with pulmonary embolism (PE) at low risk of adverse events. Conclusions: In the YEARS study, 46% of patients with PE were treated at home with low incidence of adverse events. PE-related readmission rates were not different between patients treated at home or in hospital

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