Background: Acute pulmonary embolism remains a significant cause of mortality and morbidity worldwide. Benefit of recently developed multidisciplinary PE response teams (PERT) with higher utilization of advanced therapies has not been established. Methods: To evaluate patient-centered outcomes and cost-effectiveness of a multidisciplinary PERT we performed a retrospective analysis of 554 patients with acute PE at the university of Virginia between July 2014 and June 2015 (pre-PERT era) and between April 2017 through October 2018 (PERT era). Six-month survival, hospital length-of-stay (LOS), type of PE therapy, and in-hospital bleeding were assessed upon collected data. Results: 317 consecutive patients were treated for acute PE during an 18-month period following institution of a multidisciplinary PE program; for 120 patients PERT was activated (PA), the remaining 197 patients with acute PE were considered as a separate, contemporary group (NPA). The historical, comparator cohort (PP) was composed of 237 patients. These 3 groups were similar in terms of baseline demographics, comorbidities and risk, as assessed by the Pulmonary Embolism Severity Index (PESI). Patients in the historical cohort demonstrated worsened survival when compared with patients treated during the PERT era. During the PERT era no statistically significant difference in survival was observed in the PA group when compared to the NPA group despite significantly higher severity of illness among PA patients. Hospital LOS was not different in the PA group when compared to either the NPA or PP group. Hospital costs did not differ among the 3 cohorts. 30-day re-admission rates were significantly lower during the PERT era. Rates of advanced therapies were significantly higher during the PERT era (9.1% vs. 2%) and were concentrated in the PA group (21.7% vs. 1.5%) without any significant rise in in-hospital bleeding complications.

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Introduction: Hepatic congestion with abnormal liver function tests (LFTs), including aspartate aminotransferase (AST), alanine aminotransferase (ALT) and total bilirubin (TBL) complicates acute decompensated heart failure (ADHF). The prognostic implication of abnormal LFTs in ADHF is less studied. Hypothesis: We hypothesized that abnormal LFTs would be associated with unfavorable outcomes in the Cardiorenal Rescue Study in Acute Decompensated Heart Failure (CARRESS) trial. Methods: Cox proportional hazards analysis was performed to assess the association between LFTs (AST, ALT and TBL) at baseline in the CARRESS trial with adverse clinical outcomes, including death, death or HF rehospitalization, and death or any rehospitalization. Correlation analysis was used to assess the relationship between baseline LFTs and BNP, a surrogate of cardiac filling pressures. Results: Among 188 patients (67.9 ± 12.8 years, 25% female), 15.4% died, 35.5% died or had a HF rehospitalization, and 53.8% died or were rehospitalized for any reason. Elevated TBL at baseline was associated with an increased risk of death or rehospitalization for any reason (HR 1.65 per each mg/dL increase in total TBL, 95% CI 1.15-2.38, P=0.007), and a TBL in the upper quartile (> 1.2 mg/dL) was associated with an increased risk of death or HF hospitalization (HR 1.96, 95% CI 1.11-3.45, P=0.02) (Figure). Total bilirubin and BNP at baseline were moderately correlated (r=0.34, P=0.007). There were also no significant associations for AST or ALT with any of the clinical outcomes (P>0.20 for all). Conclusion: Total bilirubin was independently associated with adverse events in ADHF and was also correlated with BNP, a marker of increased cardiac filling pressures. More studies are needed to better define the implications of abnormal LFTs in other HF phenotypes.

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