Changes in Care for Acute Pulmonary Embolism Through A Multidisciplinary Pulmonary Embolism Response Team

Am J Med. 2020 Nov;133(11):1313-1321.e6. doi: 10.1016/j.amjmed.2020.03.058. Epub 2020 May 19.

Abstract

Background: Optimal management of acute pulmonary embolism requires expertise offered by multiple subspecialties. As such, pulmonary embolism response teams (PERTs) have increased in prevalence, but the institutional consequences of a PERT are unclear.

Methods: We compared all patients that presented to our institution with an acute pulmonary embolism in the 3 years prior to and 3 years after the formation of our PERT. The primary outcome was in-hospital pulmonary embolism-related mortality before and after the formation of the PERT. Sub-analyses were performed among patients with elevated-risk pulmonary embolism.

Results: Between August 2012 and August 2018, 2042 patients were hospitalized at our institution with acute pulmonary embolism, 884 (41.3%) pre-PERT implementation and 1158 (56.7%) post-PERT implementation, of which 165 (14.2%) were evaluated by the PERT. There was no difference in pulmonary embolism-related mortality between the two time periods (2.6% pre-PERT implementation vs 2.9% post-PERT implementation, P = .89). There was increased risk stratification assessment by measurement of cardiac biomarkers and echocardiograms post-PERT implementation. Overall utilization of advanced therapy was similar between groups (5.4% pre-PERT implementation vs 5.4% post-PERT implementation, P = 1.0), with decreased use of systemic thrombolysis (3.8% pre-PERT implementation vs 2.1% post-PERT implementation, P = 0.02) and increased catheter-directed therapy (1.3% pre-PERT implementation vs 3.3% post-PERT implementation, P = 0.05) post-PERT implementation. Inferior vena cava filter use decreased after PERT implementation (10.7% pre-PERT implementation vs 6.9% post-PERT implementation, P = 0.002). Findings were similar when analyzing elevated-risk patients.

Conclusion: Pulmonary embolism response teams may increase risk stratification assessment and alter application of advanced therapies, but a mortality benefit was not identified.

Keywords: Catheter-directed thrombolysis; Inferior vena cava filters, Pulmonary embolism, Response teams, Systemic thrombolysis.

MeSH terms

  • Aged
  • Cause of Death
  • Echocardiography / statistics & numerical data
  • Embolectomy / methods*
  • Erythrocyte Transfusion / statistics & numerical data
  • Extracorporeal Membrane Oxygenation / methods*
  • Female
  • Heart Ventricles / diagnostic imaging
  • Hemorrhage / epidemiology*
  • Hemorrhage / therapy
  • Hospital Mortality*
  • Humans
  • Intracranial Hemorrhages / epidemiology
  • Length of Stay / statistics & numerical data
  • Logistic Models
  • Male
  • Middle Aged
  • Natriuretic Peptide, Brain / blood
  • Patient Care Team*
  • Patient Readmission / statistics & numerical data
  • Peptide Fragments / blood
  • Pulmonary Embolism / blood
  • Pulmonary Embolism / diagnostic imaging
  • Pulmonary Embolism / mortality
  • Pulmonary Embolism / therapy*
  • Referral and Consultation*
  • Thrombolytic Therapy / methods*
  • Tomography, X-Ray Computed
  • Vena Cava Filters / statistics & numerical data
  • Venous Thrombosis / diagnostic imaging
  • Venous Thrombosis / epidemiology
  • Ventricular Dysfunction, Right / diagnostic imaging
  • Ventricular Dysfunction, Right / epidemiology

Substances

  • Peptide Fragments
  • pro-brain natriuretic peptide (1-76)
  • Natriuretic Peptide, Brain