IMPACT OF PULMONARY EMBOLISM RESPONSE TEAM (PERT) ON TIME TO ANTICOAGULATION AND INTERVENTION IN HIGH- AND INTERMEDIATE-RISK PULMONARY EMBOLISM

Abstract

SESSION TITLE: Expanding Considerations in Management of Pulmonary EmbolismSESSION TYPE: Rapid Fire Original InvPRESENTED ON: 10/19/2022 11:15 am - 12:15 pmPURPOSE: Pulmonary embolism response teams (PERT) are being formed in many hospitals for rapid risk-stratification and treatment-initiation in patients with high and intermediate-risk pulmonary embolism (PE). Prompt diagnosis and treatment improves outcomes in PE. Limited data exists on whether institution of PERT changes outcomes. The goal of this study was to determine whether starting PERT in our institution improved time to (i) initiation of anticoagulation (AC), (ii) achieving therapeutic AC and (iii) starting advance treatments like catheter-directed thrombolysis (CDT) in high/intermediate-risk PEs.METHODS: Records of patients hospitalized in our institution with high and intermediate-risk PE, before and after starting PERT, were reviewed. Intermediate-risk (submassive) pulmonary embolism (PE) was defined as PE with presence of right ventricle (RV) dysfunction and/or elevated troponin levels and normal blood pressure, while high-risk (massive) PE was defined as patients with hypotension. 42 patients were studied before PERT was started and 93 patients after PERT. Patient demographics, time to initiation of AC and achieving therapeutic PTT, time to CDT was noted 2-years before and 2-yrs after PERT was formed. Independent t-test was performed to determine if outcomes studied were significantly impacted after the formation of PERT. p ≤ 0.05 was deemed statistically significant.RESULTS: Mean age of patients was 64 ± 15.7 years; 49% were females. Mean time to AC pre-PERT was 91.3 ± 90.3 min vs.111±114m post-PERT (p = 0.40). Time- to- CDT also did not change significantly( 1486.5±1346m pre- PERT vs.2290±1683 post-PERT (p = 0.29). There was a significant reduction in time to therapeutic PTT (925.3±636min, pre-PERT vs. 507 +264min post-PERT, p= 0.0007.CONCLUSIONS: PERT significantly reduced time to therapeutic anticoagulation in high and intermediate-risk PEs, but not on time to initiation of AC and CDT. Whether this translates to reduced hemodynamic complications and mortality needs to be further studied. Further studies are needed to assess whether mortality and other outcomes that are improved with PERT.CLINICAL IMPLICATIONS: PERT may improve outcomes in PE by enabling quicker achievement of therapeutic AC. Further studies on impact of PERT on mortality and hemodynamic complications are needed.DISCLOSURES: No relevant relationships by Soontharee CongreteNo relevant relationships by Debapriya DattaNo relevant relationships by Michelle Zur SESSION TITLE: Expanding Considerations in Management of Pulmonary Embolism SESSION TYPE: Rapid Fire Original Inv PRESENTED ON: 10/19/2022 11:15 am - 12:15 pm PURPOSE: Pulmonary embolism response teams (PERT) are being formed in many hospitals for rapid risk-stratification and treatment-initiation in patients with high and intermediate-risk pulmonary embolism (PE). Prompt diagnosis and treatment improves outcomes in PE. Limited data exists on whether institution of PERT changes outcomes. The goal of this study was to determine whether starting PERT in our institution improved time to (i) initiation of anticoagulation (AC), (ii) achieving therapeutic AC and (iii) starting advance treatments like catheter-directed thrombolysis (CDT) in high/intermediate-risk PEs. METHODS: Records of patients hospitalized in our institution with high and intermediate-risk PE, before and after starting PERT, were reviewed. Intermediate-risk (submassive) pulmonary embolism (PE) was defined as PE with presence of right ventricle (RV) dysfunction and/or elevated troponin levels and normal blood pressure, while high-risk (massive) PE was defined as patients with hypotension. 42 patients were studied before PERT was started and 93 patients after PERT. Patient demographics, time to initiation of AC and achieving therapeutic PTT, time to CDT was noted 2-years before and 2-yrs after PERT was formed. Independent t-test was performed to determine if outcomes studied were significantly impacted after the formation of PERT. p ≤ 0.05 was deemed statistically significant. RESULTS: Mean age of patients was 64 ± 15.7 years; 49% were females. Mean time to AC pre-PERT was 91.3 ± 90.3 min vs.111±114m post-PERT (p = 0.40). Time- to- CDT also did not change significantly( 1486.5±1346m pre- PERT vs.2290±1683 post-PERT (p = 0.29). There was a significant reduction in time to therapeutic PTT (925.3±636min, pre-PERT vs. 507 +264min post-PERT, p= 0.0007. CONCLUSIONS: PERT significantly reduced time to therapeutic anticoagulation in high and intermediate-risk PEs, but not on time to initiation of AC and CDT. Whether this translates to reduced hemodynamic complications and mortality needs to be further studied. Further studies are needed to assess whether mortality and other outcomes that are improved with PERT. CLINICAL IMPLICATIONS: PERT may improve outcomes in PE by enabling quicker achievement of therapeutic AC. Further studies on impact of PERT on mortality and hemodynamic complications are needed. DISCLOSURES: No relevant relationships by Soontharee Congrete No relevant relationships by Debapriya Datta No relevant relationships by Michelle Zur