Impact of pulmonary embolism response teams on acute pulmonary embolism: a systematic review and meta-analysis

Sosa, D. Fleitas; Lehr, A.; Zhao, Huaqing; Roth, Stéphanie; Lakhther, Vlad; Bashir, Riyaz; Cohen, Gary; Panaro, J.; Maldonado, Thomas S; Horowitz, James; Amoroso, Nancy; Criner, Gerard J.; Brosnahan, Shari B.; Rali, Parth

doi:10.1183/16000617.0023-2022

Cited by 33 publications

(19 citation statements)

References 41 publications

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“…The similar utilization of advanced therapy between the races is reassuring because it suggests that the quality of in‐hospital care may not be markedly different between racial groups at our institution. This may be explained by our institution's utilization of PERT, which has proven to standardize PE care 7,8 . Further studies, however, still need to be completed with comparison to a cohort of patients predating PERT at our institution to completely understand the role of PERT in our data.…”

Section: Discussionmentioning

confidence: 97%

PERT era, race‐based healthcare disparities in a large urban safety net hospital

Dronamraju,

Lio,

Badlani

et al. 2023

Pulm. circ.

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Pulmonary embolism (PE) is the third leading cause of cardiovascular death in the United States. Black Americans have higher incidence, greater clot severity, and worse outcomes than White Americans. This disparity is not fully understood, especially in the context of the advent of PE response teams (PERT), which aim to standardize PE‐related care. This retrospective single‐center cohort study compared 294 Black and 131 White patients from our institution's PERT database. Primary objectives included severity and in‐hospital management. Secondary outcomes included length of stay, 30‐day readmission, 30‐day mortality, and outpatient follow‐up. Clot (p = 0.42), acute treatment (p = 0.28), 30‐day mortality (p = 0.77), 30‐day readmission (p = 0.50), and outpatient follow‐up (p = 0.98) were similar between races. Black patients had a lower mean household income ($35,383, SD 20,596) than White patients ($63,396, SD 32,987) (p < 0.0001). More Black patients (78.8%) had exclusively government insurance (Medicare/Medicaid) compared to White patients (61.8%) (p = 0.006). Interestingly, government insurance patients had less follow‐up (58.3%) than private insurance patients (79.7%) (p = 0.001). Notably, patients with follow‐up had fewer 30‐day readmissions. Specifically, 12.2% of patients with follow‐up were readmitted compared to 22.2% of patients without follow‐up (p = 0.008). There were no significant differences in PE severity, in‐hospital treatment, mortality, or readmissions between Black and White patients. However, patients with government insurance had less follow‐up and more readmissions, indicating a socioeconomic disparity. Access barriers such as health literacy, treatment cost, and transportation may contribute to this inequity. Improving access to follow‐up care may reduce the disparity in PE outcomes.

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Section: Discussionmentioning

confidence: 97%

PERT era, race‐based healthcare disparities in a large urban safety net hospital

Dronamraju,

Lio,

Badlani

et al. 2023

Pulm. circ.

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“…Meta-analyses on the efficacy of PERT currently show a trend towards a survival benefit, particularly so in intermediate- and high-risk patients. 5 18 19 The establishment of multidisciplinary PERT in German hospitals is recommended. 4 They pursue the overall goal of coordinating and accelerating treatment decisions and their implementation in acute, potentially life-threatening PEs (high and intermediate–high risk).…”

Section: Treatment For Patients With High-risk Pulmonary Embolismmentioning

confidence: 99%

Intensive Care Treatment of Pulmonary Embolism: An Update Based on the Revised AWMF S2k Guideline

Janssens

2024

Hamostaseologie

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Acute pulmonary embolism (PE) remains a significant cause of morbidity and requires prompt diagnosis and management. The prognosis of affected patients depends on the clinical severity. Therefore, risk stratification is imperative for therapeutic decision-making. Patients with high-risk PE need intensive care. These include patients who have successfully survived resuscitation, with obstructive shock or persistent haemodynamic instability. Bedside diagnostics by means of sonographic procedures are of outstanding importance in this high-risk population. In addition to the treatment of hypoxaemia with noninvasive and invasive techniques, the focus is on drug-based haemodynamic stabilisation and usually requires the elimination or reduction of pulmonary vascular thrombotic obstruction by thrombolysis. In the event of a contraindication to thrombolysis or failure of thrombolysis, various catheter-based procedures for thrombus extraction and local thrombolysis are available today and represent an increasing alternative to surgical embolectomy. Mechanical circulatory support systems can bridge the gap between circulatory arrest or refractory shock and definitive stabilisation but are reserved for centres with the appropriate expertise. Therapeutic strategies for patients with intermediate- to high-risk PE in terms of reduced-dose thrombolytic therapy or catheter-based procedures need to be further evaluated in prospective clinical trials.

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“…Pulmonary embolism (PE) is the third most common cause of cardiovascular death in the United States [1] with an estimated mortality approaching 300,000 annually [2]. The advent of the multidisciplinary pulmonary embolism response team (PERT) and novel minimally invasive catheter-based treatments has led to a reduction in mortality [3][4][5]. Yet, despite the improvements gained, there is a pressing need to identify patients who are at a higher risk of morbidity and mortality.…”

Section: Introductionmentioning

confidence: 99%

The Obesity Mortality Paradox in Patients with Pulmonary Embolism: Insights from a Tertiary Care Center

Alkhalfan,

Bukhari,

Rosenzveig

et al. 2024

JCM

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Background: While obesity is associated with an increased risk of venous thromboembolism (VTE), there is some data to suggest that higher BMI is also associated with decreased all-cause mortality in patients with a pulmonary embolism (PE). Methods: Using PE Response Team (PERT) activation data from a large tertiary hospital between 27 October 2020 and 28 August 2023, we constructed a multivariate Cox proportional hazards model to assess the association between obesity as a dichotomous variable (defined as BMI ≥ 30 vs. BMI 18.5–29.9), BMI as a continuous variable, and 30-day PE-related mortality. Results: A total of 248 patients were included in this analysis (150 with obesity and 98 who were in the normal/overweight category). Obesity was associated with a lower risk of 30-day PE-related mortality (adjusted HR 0.29, p = 0.036, 95% CI 0.09–0.92). A higher BMI was paradoxically associated with a lower risk of PE-related mortality (HR = 0.91 per 1 kg/m2 increase, p = 0.049, 95% CI 0.83–0.999). Conclusions: In our contemporary cohort of patients with a PERT activation, obesity was associated with a lower risk of PE-related mortality.

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Impact of pulmonary embolism response teams on acute pulmonary embolism: a systematic review and meta-analysis

Cited by 33 publications

References 41 publications

PERT era, race‐based healthcare disparities in a large urban safety net hospital

PERT era, race‐based healthcare disparities in a large urban safety net hospital

Intensive Care Treatment of Pulmonary Embolism: An Update Based on the Revised AWMF S2k Guideline

The Obesity Mortality Paradox in Patients with Pulmonary Embolism: Insights from a Tertiary Care Center

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