TY - JOUR
T1 - Current practice patterns of outpatient management of acute pulmonary embolism: A post-hoc analysis of the YEARS study
AU - Hendriks, Stephan V.
AU - Bavalia, Roisin
AU - van Bemmel, Thomas
AU - Bistervels, Ingrid M.
AU - Eijsvogel, Michiel
AU - Faber, Laura M.
AU - the YEARS investigators
AU - Fogteloo, Jaap
AU - Hofstee, Herman M. A.
AU - van der Hulle, Tom
AU - Iglesias del Sol, Antonio
AU - Kruip, Marieke J. H. A.
AU - Mairuhu, Albert T. A.
AU - Middeldorp, Saskia
AU - Nijkeuter, Mathilde
AU - Huisman, Menno V.
AU - Klok, Frederikus A.
PY - 2020/9/1
Y1 - 2020/9/1
N2 - Background: Studies have shown the safety of home treatment of patients with pulmonary embolism (PE) at low risk of adverse events. Management studies focusing on home treatment have suggested that 30% to 55% of acute PE patients could be treated at home, based on the HESTIA criteria, but data from day-to-day clinical practice are largely unavailable. Aim: To determine current practice patterns of home treatment of acute PE in the Netherlands. Method: We performed a post-hoc analysis of the YEARS study. The main outcomes were the proportion of patients who were discharged <24 h and reasons for admission if treated in hospital. Further, we compared the 3-month incidence of PE-related unscheduled readmissions between patients treated at home and in hospital. Results: Of the 404 outpatients with PE included in this post-hoc analysis of the YEARS study, 184 (46%) were treated at home. The median duration of admission of the hospitalized patients was 3.0 days. The rate of PE-related readmissions of patients treated at home was 9.7% versus 8.6% for hospitalized patients (crude hazard ratio 1.1 (95% CI 0.57–2.1)). The 3-month incidence of any adverse event was 3.8% in those treated at home (2 recurrent VTE, 3 major bleedings and two deaths) compared to 10% in the hospitalized patients (3 recurrent VTE, 6 major bleedings and fourteen deaths). Conclusions: In the YEARS study, 46% of patients with PE were treated at home with low incidence of adverse events. PE-related readmission rates were not different between patients treated at home or in hospital.
AB - Background: Studies have shown the safety of home treatment of patients with pulmonary embolism (PE) at low risk of adverse events. Management studies focusing on home treatment have suggested that 30% to 55% of acute PE patients could be treated at home, based on the HESTIA criteria, but data from day-to-day clinical practice are largely unavailable. Aim: To determine current practice patterns of home treatment of acute PE in the Netherlands. Method: We performed a post-hoc analysis of the YEARS study. The main outcomes were the proportion of patients who were discharged <24 h and reasons for admission if treated in hospital. Further, we compared the 3-month incidence of PE-related unscheduled readmissions between patients treated at home and in hospital. Results: Of the 404 outpatients with PE included in this post-hoc analysis of the YEARS study, 184 (46%) were treated at home. The median duration of admission of the hospitalized patients was 3.0 days. The rate of PE-related readmissions of patients treated at home was 9.7% versus 8.6% for hospitalized patients (crude hazard ratio 1.1 (95% CI 0.57–2.1)). The 3-month incidence of any adverse event was 3.8% in those treated at home (2 recurrent VTE, 3 major bleedings and two deaths) compared to 10% in the hospitalized patients (3 recurrent VTE, 6 major bleedings and fourteen deaths). Conclusions: In the YEARS study, 46% of patients with PE were treated at home with low incidence of adverse events. PE-related readmission rates were not different between patients treated at home or in hospital.
KW - Acute pulmonary embolism
KW - Ambulatory care
KW - Daily practice
KW - Outpatients
KW - Readmissions
UR - http://www.scopus.com/inward/record.url?scp=85085989177&partnerID=8YFLogxK
U2 - https://doi.org/10.1016/j.thromres.2020.05.038
DO - https://doi.org/10.1016/j.thromres.2020.05.038
M3 - Article
C2 - 32521336
SN - 0049-3848
VL - 193
SP - 60
EP - 65
JO - Thrombosis research
JF - Thrombosis research
ER -