Rate and duration of hospitalization for deep vein thrombosis and pulmonary embolism in real-world clinical practice

Dentali, Francesco; Micco, Gianluca Di; Giorgi‐Pierfranceschi, Matteo; Gussoni, Gualberto; Barillari, Giovanni; Amitrano, María; Fontanella, Andrea; Lodigiani, Corrado; Guida, Anna; Visonà, Adriana; Monréal, Manuel; Micco, Pierpaolo Di

doi:10.3109/07853890.2015.1085127

Cited by 38 publications

(29 citation statements)

References 17 publications

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“…Home treatment may improve satisfaction with treatment and more generally the quality of life of patients with acute PE; in addition, it may help to reduce costs as well as potential health risks related to unnecessary hospitalization. This is particularly important in view of the fact that, in many countries, patients with acute PE are still hospitalized for several days 3–5 . Cohort studies and randomized controlled trials, which investigated the efficacy and safety of ambulatory PE treatment in the vitamin K antagonist (VKA) era, used mainly clinical severity scores for patient selection 6–9 .…”

Section: Introductionmentioning

confidence: 99%

Prognostic value of right ventricular dysfunction or elevated cardiac biomarkers in patients with low-risk pulmonary embolism: a systematic review and meta-analysis

Barco

Mahmoudpour

Planquette

et al. 2018

European Heart Journal

213

131

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AimsPatients with acute pulmonary embolism (PE) classified as low risk by the Pulmonary Embolism Severity Index (PESI), its simplified version (sPESI), or the Hestia criteria may be considered for early discharge. We investigated whether the presence of right ventricular (RV) dysfunction may aggravate the early prognosis of these patients.Methods and resultsWe did a systematic review and meta-analysis of studies including low-risk patients with acute PE to investigate the prognostic value of RV dysfunction. Diagnosis of RV dysfunction was based on echocardiography or computed tomography pulmonary angiography. In addition, we investigated the prognostic value of elevated troponin or natriuretic peptide levels. The primary outcome was all-cause mortality at 30 days or during hospitalization. We included 22 studies (N = 3295 low-risk patients) in the systematic review: 21 were selected for quantitative analysis. Early all-cause mortality rates in patients with vs. without RV dysfunction on imaging were 1.8% [95% confidence interval (CI) 0.9–3.5%] vs. 0.2% (95% CI 0.03–1.7%), respectively, [odds ratio (OR) 4.19, 95% CI 1.39–12.58]. For troponins, rates were 3.8% (95% CI 2.1–6.8%) vs. 0.5% (95% CI 0.2–1.3%), (OR 6.25, 95% CI 1.95–20.05). For natriuretic peptides, only data on early PE-related mortality were available: rates were 1.7% (95% CI 0.4–6.9%) vs. 0.4% (95% CI 0.1–1.1%), (OR 3.71, 95% CI 0.81–17.02).ConclusionsIn low-risk patients with acute PE, the presence of RV dysfunction on admission was associated with early mortality. Our results may have implications for the management of patients who appear at low risk based on clinical criteria alone, but present with RV dysfunction as indicated by imaging findings or laboratory markers.

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Section: Introductionmentioning

confidence: 99%

Prognostic value of right ventricular dysfunction or elevated cardiac biomarkers in patients with low-risk pulmonary embolism: a systematic review and meta-analysis

Barco

Mahmoudpour

Planquette

et al. 2018

European Heart Journal

213

131

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“…Current guidelines suggest that the approximately 30% to 55% of patients with PE who are at low mortality risk may be suitable for early discharge and outpatient treatment . Nonetheless, clinical trial and real‐world data suggest that 80% to 98% of patients diagnosed with PE are admitted to hospital . The necessity of this strategy is unclear, because some centers have established outpatient treatment pathways that result in ~50% to 70% of patients with PE receiving outpatient therapy .…”

Section: Introductionmentioning

confidence: 99%

Reducing the hospital burden associated with the treatment of pulmonary embolism

Peacock

Singer

2019

Journal of Thrombosis and Haemostasis

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Summary Pulmonary embolism (PE) is the most feared clinical presentation of venous thromboembolism (VTE). Patients with PE have traditionally been treated in hospital; however, many are at low risk of adverse outcomes and current guidelines suggest outpatient treatment as an option. Outpatient treatment of PE offers several advantages, including reduced risk of hospital‐acquired conditions and potential cost savings. Despite this, patients with low‐risk PE are still frequently hospitalized for treatment. This narrative review summarizes current guideline recommendations for the identification of patients with low‐risk PE who are potentially suitable for outpatient treatment, using prognostic assessment tools (e.g. the Pulmonary Embolism Severity Index [PESI] and simplified PESI) and clinical exclusion criteria (e.g. Hestia criteria) alone or in combination with additional cardiac assessments. Treatment options are discussed along with recommendations for the follow‐up of patients managed in the non‐hospital environment. The available data on outpatient treatment of PE are summarized, including details on patient selection, anticoagulant choice, and short‐term outcomes in each study. Accumulating evidence suggests that outcomes in patients with low‐risk PE treated as outpatients are at least as good as, if not better than, those of patients treated in the hospital. With mounting pressures on health care systems worldwide, increasing the proportion of patients with PE treated as outpatients has the potential to reduce health care burdens associated with VTE.

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“…Rate and duration of hospitalisation for deep vein thrombosis and pulmonary embolism in real-world clinical practice (2015). 16 …”

Section: List Of Quality Statementsmentioning

confidence: 99%

British Thoracic Society Quality Standards for outpatient management of pulmonary embolism

et al. 2020

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IntroductionThe purpose of the quality standards document is to provide healthcare professionals, commissioners, service providers and patients with a guide to standards of care that should be met for outpatient management of pulmonary embolism in the UK, together with measurable markers of good practice. Quality statements are based on the British Thoracic Society (BTS) Guideline for the Initial Outpatient Management of Pulmonary Embolism.MethodsDevelopment of BTS Quality Standards follows the BTS process of quality standard production based on the National Institute for Health and Care Excellence process manual for the development of quality standards.ResultsSix quality statements have been developed, each describing a standard of care for the outpatient management of pulmonary embolism in the UK, together with measurable markers of good practice.DiscussionBTS Quality Standards for Outpatient Management of Pulmonary Embolism form a key part of the range of supporting materials that the society produces to assist in the dissemination and implementation of a guideline’s recommendations.

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Rate and duration of hospitalization for deep vein thrombosis and pulmonary embolism in real-world clinical practice

Abstract: One in every two patients with DVT and five in every six with PE are still hospitalized.

Cited by 38 publications

References 17 publications

Prognostic value of right ventricular dysfunction or elevated cardiac biomarkers in patients with low-risk pulmonary embolism: a systematic review and meta-analysis

Prognostic value of right ventricular dysfunction or elevated cardiac biomarkers in patients with low-risk pulmonary embolism: a systematic review and meta-analysis

Reducing the hospital burden associated with the treatment of pulmonary embolism

British Thoracic Society Quality Standards for outpatient management of pulmonary embolism

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