IMPACT OF PULMONARY EMBOLISM RESPONSE TEAM ON PATIENT OUTCOMES INCLUDING 30-DAY READMISSION RATES

Abstract

SESSION TITLE: Monday Abstract Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/21/2019 02:30 PM - 03:15 PM PURPOSE: The rationale for Pulmonary Embolism Response Teams (PERT) is to optimize care for patients at high risk of mortality from acute Pulmonary Embolism (PE), by providing real-time, multidisciplinary consultation. We hypothesized that a PERT-based approach would optimize PE management and decrease readmission rates. METHODS: We performed a retrospective analysis of all 54 consecutive PERT activations over 2018 from two urban tertiary academic hospitals, to determine impact of PERT-guided therapy. We analyzed patient characteristics, and focused on significant outcomes including: in-hospital mortality, major bleeding as defined by the International Society of Thrombosis and Hemostasis (2015), 30-day readmission and clinic follow up. RESULTS: Median age was 64 years. 52% were women. There were 6 in-hospital deaths (11%), all of which were High Risk (HR) based on European Society of Cardiology classification. Cause of death was PE (n=4, 7%), major bleeding (n=1, 2%) and pneumonia (n=1, 2%). Major bleeding occurred in 4 (7%) patients, which was fatal in 1 (2%). Two patients on systemic anticoagulation (AC) alone and one post-catheter directed thrombolysis (CDT) developed major bleeding, necessitating inferior vena cava (IVC) filter placement. 47 (87%) patients were discharged and 6 (12%) were re-admitted within 30-days: 1 patient expired from massive PE and one suffered anticoagulation related gastrointestinal bleed. Four (8%) Non-PE related readmissions included one each for pneumonia, urinary tract infection, seizure, and bowel obstruction. One (11%) patient who had undergone CDT was readmitted within 30-days. 33 (70%) patients were seen within a month at either Internal Medicine or Pulmonary Clinics and 2 (4%) patients were discharged to hospice. CONCLUSIONS: Our data demonstrates comparable outcomes of PERT managed acute PE patients, compared to data from other PERT centers, with minimal PE-related mortality, major bleeding, and low rate of recurrent PE and re-admissions. CLINICAL IMPLICATIONS: Longer term follow up is needed to evaluate cardiac function and possible development of chronic thromboembolic pulmonary hypertension (CTEPH), bleeding risk from extended anticoagulation, and ensure appropriate IVC filter retrieval. DISCLOSURES: No relevant relationships by Madeline Ehrlich, source=Web Response No relevant relationships by Jason Filopei, source=Web Response No relevant relationships by James Salonia, source=Web Response No relevant relationships by Janet Shapiro, source=Web Response No relevant relationships by Adil Shujaat, source=Web Response No relevant relationships by Avinash Singh, source=Web Response No relevant relationships by David Steiger, source=Web Response No relevant relationships by Sean Zajac, source=Web Response