Heart Rate and Mortality in Patients With Acute Symptomatic Pulmonary Embolism

Jaureguizar, Ana; Muriel, Alfonso; Tapson, Victor F.; Kenet, Gili; Micco, Pierpaolo Di; Reis, Abílio; Adarraga, MD; Aibar, Jesús; Aibar, M.A.; Alonso, J.; Amado, Cristina; Arcelus, J.I.; Asuero, A; Azcárate-Agüero, Pedro María; Ballaz, Aitor; Barba, Raquel; Barbagelata, Carlos; Barrón, M.; Barrón‐Andrés, B.; Blanco-Molina, Ángeles; Chaib, Fahd Beddar; Camon, A.M.; Castro, Joaquín; Chasco, Leyre; Criado, Juan Carlos Hernández; Ancos, Cristina de; Toro, J. del; Demelo‐Rodríguez, Pablo; Díaz-Brasero, A.M.; Díaz-Pedroche, M.C.; Díaz-Peromingo, J.A.; Campli, M; Dubois-Silva, Álvaro; Escribano, JC; Espósito, F.; Farfán-Sedano, Ana Isabel; Fernández‐Capitán, Carmen; Fernández‐Reyes, José Luis; Fidalgo, M.A.; Flores, Katia; Font, Carme; Font, Llorenç; Francisco, Iria; Gabara, Cristina; Galeano‐Valle, Francisco; García, M.A.; García‐Bragado, F.; Herreros, Marta García de; Garza, Rocío García de la; García‐Díaz, C; Gil-Díaz, Aída; Gómez-Cuervo, Covadonga; Giménez-Suau, M.; Grau, E; Guirado, L.; Gutiérrez, J.; Hernández‐Blasco, Luis; Jara‐Palomares, Luis; Jaras, M.J.; Jiménez, David; Jiménez‐Alfaro, C; Joya, M.D.; Lainez‐Justo, S; Latorre, A; Lima, Jorge Roberto Perrout de; Lobo, José Luís; López-Jiménez, Luciano; López-Miguel, Patricia; López‐Núñez, JJ; López‐Reyes, Raquel; López-Sáez, J.B.; Lorenzo, Alicia; Madridano, Olga; Maestre, Ana; Marchena, PJ; Pozo, M. Martín del; Martín-Martos, F.; Martínez-Urbistondo, Diego; Mella, C; Mercado, MI; Moisés, Jorge; Monreal, Manuel; Muñoz, Maria Eugenia Torguet; Muñoz-Blanco, Arturo; Nieto, J.A.; Nofuentes-Pérez, E; Núñez-Fernández, M.J.; Olid-Velilla, M.; Olivares, MC; Osorio, Jeisson; Otalora, S.; Otero, Remedios; Pedrajas, José María; Pellejero, G; Porras, José Antonio; Portillo, J M; Rodríguez-Matute, Consolación; Rosa, Vladimir; Ruíz-Artacho, Pedro; Ruiz-Ruiz, Justo; Salgueiro, Giorgina; Sánchez-Martínez, R.; Sánchez-Muñoz-Torrero, J.F.; Sancho, Teresa; Soler, Silvia; Suárez‐Rodríguez, B; Suriñach, José María; Torres, M.I.; Tolosa, Carles; Trujillo‐Santos, Javier; Uresandi, Fernando; Valero, B.; Valle, Reina; Varona, J.F.; Vela, Lydia; Vela, J.; Vidal, G.; Villalobos, Aurora; Villares, Paula; Zamora, C; Ay, Cihan; Nopp, Stephan; Pabinger, Ingrid; Vanassche, Thomas; Vandenbriele, Christophe; Verhamme, Peter; Hirmerová, Jana; Malý, Radován; Accassat, Sandrine; Abdallah, Nassim Ait; Bertoletti, Laurent; Bura-Rivière, A.; Catella, Judith; Couturaud, Francis; Crichi, Benjamin; Debourdeau, Philippe; Espitia, O.; Farge‐Bancel, Dominique; Grangé, C.; Helfer, H. L.; Lacut, Karine; Mao, Raphaël Le; Mahé, I.; Morange, Pierre‐Emmanuel; Moustafa, Farès; Poénou, Géraldine; Sarlon-Bartoli, G.; Suchon, Pierre; Quéré, Isabelle; Schellong, Sebastian; Braester, Andrei; Brenner, Benjamin; Tzoran, Inna; Basaglia, Manuela; Bilora, Franca; Bortoluzzi, Cristiano; Brandolin, Barbara; Ciammaichella, Maurizio; Angelis, A. De; Micco, P. Di; Imbalzano, Egidio; Merla, Simona; Pesavento, Raffaele; Prandoni, Paolo; Siniscalchi, Carmine; Tufano, Antonella; Visonà, Adriana; Hong, Ngoc Vo; Zalunardo, Beniamino; Nishimoto, Yuji; Sato, Yu; Birzulis, J.; Skride, Andris; Zaicenko, A.; Fonseca, S; Martins, F; Meireles, J.; Bosevski, Marijan; Krstevski, Gorjan; Bounameaux, Henri; Mazzolai, Lucia; Bikdeli, Behnood; Caprini, Joseph A.; Bui, Hanh My

doi:10.1016/j.chest.2021.08.059

Cited by 26 publications

(7 citation statements)

References 25 publications

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“…In fact, none of the low-risk patients in the intervention arm experienced short-term complications. Nevertheless, a prognostic guided management still reduced the LOS by 3 days among low-risk patients, and the mean LOS in the intervention group was not different to that among patients who enrolled the clinical trials of outpatient therapy ( 11 , 21 , 22 ).…”

Section: Discussionmentioning

confidence: 86%

“…Compared to previous studies ( 11 , 21 ), our trial used a heart rate less than 100/min as a predefined criterion for discharge. Though the sPESI (which uses a heart rate cutoff of 110/min) has been reported to be helpful to identify low-risk PE patients who might be suitable for home therapy, recent data suggest that a lower heart rate at admission might portend a more favorable prognosis with respect to mortality ( 22 ). In fact, none of the low-risk patients in the intervention arm experienced short-term complications.…”

Section: Discussionmentioning

confidence: 99%

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Effect of Prognostic Guided Management of Patients With Acute Pulmonary Embolism According to the European Society of Cardiology Risk Stratification Model

Jiménez

Rodrı́guez

Pintado

et al. 2022

Front. Cardiovasc. Med.

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BackgroundA recent trial showed that management driven by prognostic assessment was effective in reducing the length of stay (LOS) for acute stable pulmonary embolism (PE). The efficacy and safety of this strategy in each subgroup of risk stratification remains unknown.MethodsWe conducted a post-hoc analysis of the randomized IPEP study to evaluate the effect of a management strategy guided by early use of a prognostic pathway in the low- and intermediate-high risk subgroups defined by the European Society of Cardiology (ESC) model. These subgroups were retrospectively identified in the control arm. The primary outcome was LOS. The secondary outcomes were 30-day clinical outcomes.ResultsOf 249 patients assigned to the intervention group, 60 (24%) were classified as low-, and 30 (12%) as intermediate-high risk. Among 249 patients assigned to the control group, 66 (27%) were low-, and 13 (5%) intermediate-high risk. In the low-risk group, the mean LOS was 2.1 (±0.9) days in the intervention group and 5.3 (±2.9) days in the control group (P < 0.001). In this group, no significant differences were observed in 30-day readmissions (0% vs. 3.0%, respectively), all-cause (0% vs. 0%) and PE-related mortality rates (0% vs. 0%), or severe adverse events (0% vs. 1.5%). In the intermediate-high risk group, the mean LOS was 5.3 (±1.8) days in the intervention group and 6.5 (±2.5) days in the control group (P = 0.08). In this group, no significant differences were observed in 30-day readmissions (3.3% vs. 3.0%, respectively), all-cause (6.7% vs. 7.7%) and PE-related mortality rates (6.7% vs. 7.7%), or severe adverse events (16.7% vs. 15.4%).ConclusionThe use of a prognostic assessment and management pathway was effective in reducing the LOS for acute PE without comprising safety across subgroups of risk stratification.Clinical Trial Registration[ClinicalTrials.gov], Identifier [NCT02733198].

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Section: Discussionmentioning

confidence: 86%

Section: Discussionmentioning

confidence: 99%

Effect of Prognostic Guided Management of Patients With Acute Pulmonary Embolism According to the European Society of Cardiology Risk Stratification Model

Jiménez

Rodrı́guez

Pintado

et al. 2022

Front. Cardiovasc. Med.

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“…A recent study showed that defining tachycardia with a heart rate ≥100 bpm (instead of the 110 used in the PESI and sPESI scores) was already associated with a higher complication rate in normotensive patients with acute PE [3]. Interestingly, in another study, the heart rate was even proportionally correlated with mortality [4 ▪ ]. In this intermediate group as defined by the PESI, it is critical to identify a subgroup of patients at increased risk of early death who may potentially benefit from early reperfusion therapy.…”

Section: Risk Stratification Of Patients With Acute Pulmonary Embolismmentioning

confidence: 99%

Risk stratification and treatment of pulmonary embolism with intermediate-risk of mortality

Pastré

Sanchis-Borja

Benlounes

2022

Current Opinion in Pulmonary Medicine

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Purpose of reviewIntermediate-risk pulmonary embolisms (PE) represent a heterogeneous group at the high end of hemodynamically stable patients, characterized by a higher mortality rate. This challenging population gathers many unsolved question regarding its therapeutic management. The purpose of this review is to provide an updated overview of the literature regarding further risk stratification and treatment options in this population.Recent findingsIf anticoagulation represents the undisputed first line of treatment, some patients especially in the intermediate-high risk subgroup may necessitate or could benefit from therapeutic escalation with reperfusion therapies. This includes systemic thrombolysis (ST) or catheter-directed therapies (CDT). ST, despite its high efficacy, is not recommended in this population because of prohibitive bleeding complications. Therefore, reduced-dose ST appears to be a promising option and is actually under evaluation. CDT are percutaneous reperfusion techniques developed to acutely decrease pulmonary vascular obstruction with lower-dose or no thrombolytic agents and, thus, potentially improved safety compared to ST.SummaryGreat progress has been made in the recent years providing a wide range of therapeutic options. Optimal selection of patients who could benefit from these treatments is the key and is based on clinical, biological and radiological parameters evaluating right ventricle function and allowing accurate risk stratification. Pulmonary Embolism Response Team represents an efficient modality for therapeutic management especially in the intermediate-high risk subgroup.

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“…Another study demonstrated that high heart rate increases the risk of cardiovascular mortality associated with elevated uric acid levels 4 . In non-hypotensive patients with acute symptomatic pulmonary embolism, elevated heart rate is associated with increased all-cause mortality and pulmonary embolism-related mortality 5 . There is a scarcity of guidance recommendations regarding heart rate management in acute pancreatitis, with limited evidence supporting these recommendations.…”

Section: Introductionmentioning

confidence: 99%

Prolonged elevated heart rate and 90-Day mortality in acute pancreatitis

Xie,

Deng,

Zhang

et al. 2024

Sci Rep

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Prolonged elevated heart rate (peHR) is recognized as a risk factor for poor prognosis among critically ill patients. However, there is currently a lack of studies investigating the association between peHR and patients with acute pancreatitis. Multiparameter Intelligent Monitoring in Intensive Care IV (MIMIC-IV) database was used to identify patients with acute pancreatitis. PeHR was defined as a heart rate exceeding 100 beats per minute for at least 11 out of 12 consecutive hours. Cox regression analysis was used to assess the association between peHR and the 90-Day mortality. A total of 364 patients (48.9%) experienced a peHR episode. The 90-day mortality was 25%. PeHR is an independent risk factor for 90-day mortality (HR, 1.98; 95% CI 1.53–2.56; P < 0.001). KM survival curves exhibited a significant decrease in the survival rate at 90 days among patients who experienced a peHR episode (P < 0.001, 84.5% vs. 65.1%). We revealed a significant association of peHR with decreased survival in a large cohort of ICU patients with acute pancreatitis.

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Heart Rate and Mortality in Patients With Acute Symptomatic Pulmonary Embolism

Cited by 26 publications

References 25 publications

Effect of Prognostic Guided Management of Patients With Acute Pulmonary Embolism According to the European Society of Cardiology Risk Stratification Model

Effect of Prognostic Guided Management of Patients With Acute Pulmonary Embolism According to the European Society of Cardiology Risk Stratification Model

Risk stratification and treatment of pulmonary embolism with intermediate-risk of mortality

Prolonged elevated heart rate and 90-Day mortality in acute pancreatitis

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