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Safety of Treating Acute Pulmonary Embolism at Home
TAKE-HOME MESSAGE
- In this meta-analysis of 10 studies involving 2694 patients with acute pulmonary embolism treated at home after a validated tool–guided risk assessment, the 30-day incidences of death and adverse events were low (0.30% and 1.2%, respectively). The presence of cancer and abnormal cardiac biomarker levels were associated with an increased risk of adverse events.
- These findings suggest that validated triage tools may be used in combination with clinical judgment to safely discharge well-selected patients with acute pulmonary embolism from emergency settings to home-based treatment.
abstract
This abstract is available on the publisher's site.
Access this abstract nowBACKGROUND AND AIMS
Home treatment is considered safe in acute pulmonary embolism (PE) patients selected by a validated triage tool (e.g. simplified PE severity index score or Hestia rule), but there is uncertainty regarding the applicability in underrepresented subgroups. The aim was to evaluate the safety of home treatment by performing an individual patient-level data meta-analysis.
METHODS
Ten prospective cohort studies or randomized controlled trials were identified in a systematic search, totalling 2694 PE patients treated at home (discharged within 24 h) and identified by a predefined triage tool. The 14- and 30-day incidences of all-cause mortality and adverse events (combined endpoint of recurrent venous thromboembolism, major bleeding, and/or all-cause mortality) were evaluated. The relative risk (RR) for 14- and 30-day mortalities and adverse events is calculated in subgroups using a random effects model.
RESULTS
The 14- and 30-day mortalities were 0.11% [95% confidence interval (CI) 0.0-0.24, I2 = 0) and 0.30% (95% CI 0.09-0.51, I2 = 0). The 14- and 30-day incidences of adverse events were 0.56% (95% CI 0.28-0.84, I2 = 0) and 1.2% (95% CI 0.79-1.6, I2 = 0). Cancer was associated with increased 30-day mortality [RR 4.9; 95% prediction interval (PI) 2.7-9.1; I2 = 0]. Pre-existing cardiopulmonary disease, abnormal troponin, and abnormal (N-terminal pro-)B-type natriuretic peptide [(NT-pro)BNP] at presentation were associated with an increased incidence of 14-day adverse events [RR 3.5 (95% PI 1.5-7.9, I2 = 0), 2.5 (95% PI 1.3-4.9, I2 = 0), and 3.9 (95% PI 1.6-9.8, I2 = 0), respectively], but not mortality. At 30 days, cancer, abnormal troponin, and abnormal (NT-pro)BNP were associated with an increased incidence of adverse events [RR 2.7 (95% PI 1.4-5.2, I2 = 0), 2.9 (95% PI 1.5-5.7, I2 = 0), and 3.3 (95% PI 1.6-7.1, I2 = 0), respectively].
CONCLUSIONS
The incidence of adverse events in home-treated PE patients, selected by a validated triage tool, was very low. Patients with cancer had a three- to five-fold higher incidence of adverse events and death. Patients with increased troponin or (NT-pro)BNP had a three-fold higher risk of adverse events, driven by recurrent venous thromboembolism and bleeding.
Additional Info
Safety of treating acute pulmonary embolism at home: an individual patient data meta-analysis
Eur Heart J 2024 Jul 12;[EPub Ahead of Print], D Luijten, D Douillet, K Luijken, C Tromeur, A Penaloza, O Hugli, D Aujesky, S Barco, JR Bledsoe, KE Chang, F Couturaud, PL den Exter, C Font, MV Huisman, D Jimenez, C Kabrhel, JA Kline, S Konstantinides, T van Mens, R Otero, WF Peacock, O Sanchez, WB Stubblefield, L Valerio, DR Vinson, P Wells, M van Smeden, PM Roy, FA KlokFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.