TY - JOUR
T1 - Triaging acute pulmonary embolism for home treatment by Hestia or simplified PESI criteria
T2 - the HOME-PE randomized trial
AU - Roy, Pierre-Marie
AU - Penaloza, Andrea
AU - Hugli, Olivier
AU - Klok, Frederikus A.
AU - Arnoux, Armelle
AU - Elias, Antoine
AU - Couturaud, Francis
AU - Joly, Luc-Marie
AU - Lopez, Raphaëlle
AU - Faber, Laura M.
AU - Daoud-Elias, Marie
AU - Planquette, Benjamin
AU - Bokobza, J. rôme
AU - Viglino, Damien
AU - Schmidt, Jeannot
AU - Juchet, Henry
AU - Mahe, Isabelle
AU - Mulder, Frits
AU - Bartiaux, Magali
AU - Cren, Rosen
AU - Moumneh, Thomas
AU - Quere, Isabelle
AU - Falvo, Nicolas
AU - Montaclair, Karine
AU - Douillet, Delphine
AU - Steinier, Charlotte
AU - Hendriks, Stephan V.
AU - Benhamou, Ygal
AU - Szwebel, Tali-Anne
AU - Pernod, Gilles
AU - Dublanchet, Nicolas
AU - Lapebie, François-Xavier
AU - Javaud, Nicolas
AU - Ghuysen, Alexandre
AU - Sebbane, Mustapha
AU - Chatellier, Gilles
AU - Meyer, Guy
AU - Jimenez, David
AU - Huisman, Menno V.
AU - HOME-PE Study Group
AU - Sanchez, Olivier
N1 - Publisher Copyright: © The Author(s) 2021. Published by Oxford University Press on behalf of the European Society of Cardiology.
PY - 2021/8/31
Y1 - 2021/8/31
N2 - AIMS: The aim of this study is to compare the Hestia rule vs. the simplified Pulmonary Embolism Severity Index (sPESI) for triaging patients with acute pulmonary embolism (PE) for home treatment. METHODS AND RESULTS: Normotensive patients with PE of 26 hospitals from France, Belgium, the Netherlands, and Switzerland were randomized to either triaging with Hestia or sPESI. They were designated for home treatment if the triaging tool was negative and if the physician-in-charge, taking into account the patient's opinion, did not consider that hospitalization was required. The main outcomes were the 30-day composite of recurrent venous thrombo-embolism, major bleeding or all-cause death (non-inferiority analysis with 2.5% absolute risk difference as margin), and the rate of patients discharged home within 24 h after randomization (NCT02811237). From January 2017 through July 2019, 1975 patients were included. In the per-protocol population, the primary outcome occurred in 3.82% (34/891) in the Hestia arm and 3.57% (32/896) in the sPESI arm (P = 0.004 for non-inferiority). In the intention-to-treat population, 38.4% of the Hestia patients (378/984) were treated at home vs. 36.6% (361/986) of the sPESI patients (P = 0.41 for superiority), with a 30-day composite outcome rate of 1.33% (5/375) and 1.11% (4/359), respectively. No recurrent or fatal PE occurred in either home treatment arm. CONCLUSIONS: For triaging PE patients, the strategy based on the Hestia rule and the strategy based on sPESI had similar safety and effectiveness. With either tool complemented by the overruling of the physician-in-charge, more than a third of patients were treated at home with a low incidence of complications.
AB - AIMS: The aim of this study is to compare the Hestia rule vs. the simplified Pulmonary Embolism Severity Index (sPESI) for triaging patients with acute pulmonary embolism (PE) for home treatment. METHODS AND RESULTS: Normotensive patients with PE of 26 hospitals from France, Belgium, the Netherlands, and Switzerland were randomized to either triaging with Hestia or sPESI. They were designated for home treatment if the triaging tool was negative and if the physician-in-charge, taking into account the patient's opinion, did not consider that hospitalization was required. The main outcomes were the 30-day composite of recurrent venous thrombo-embolism, major bleeding or all-cause death (non-inferiority analysis with 2.5% absolute risk difference as margin), and the rate of patients discharged home within 24 h after randomization (NCT02811237). From January 2017 through July 2019, 1975 patients were included. In the per-protocol population, the primary outcome occurred in 3.82% (34/891) in the Hestia arm and 3.57% (32/896) in the sPESI arm (P = 0.004 for non-inferiority). In the intention-to-treat population, 38.4% of the Hestia patients (378/984) were treated at home vs. 36.6% (361/986) of the sPESI patients (P = 0.41 for superiority), with a 30-day composite outcome rate of 1.33% (5/375) and 1.11% (4/359), respectively. No recurrent or fatal PE occurred in either home treatment arm. CONCLUSIONS: For triaging PE patients, the strategy based on the Hestia rule and the strategy based on sPESI had similar safety and effectiveness. With either tool complemented by the overruling of the physician-in-charge, more than a third of patients were treated at home with a low incidence of complications.
KW - Clinical decision-making
KW - Emergency department
KW - Home treatment
KW - Pulmonary embolism
KW - Randomized controlled trial
KW - Risk assessment
UR - http://www.scopus.com/inward/record.url?scp=85110540902&partnerID=8YFLogxK
U2 - https://doi.org/10.1093/eurheartj/ehab373
DO - https://doi.org/10.1093/eurheartj/ehab373
M3 - Article
C2 - 34363386
SN - 0195-668X
VL - 42
SP - 3146
EP - 3157
JO - European Heart journal
JF - European Heart journal
IS - 33
ER -