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Multidisciplinary approach may improve outcomes for patients with pulmonary embolism
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SAN DIEGO — Use of a pulmonary embolism response service comprised of cardiologists, cardiothoracic surgeons, pulmonologists and radiologists for the care of high-risk patients with pulmonary embolism was associated with improved diagnosis and treatment, researchers reported at the Society for Cardiovascular Angiography and Interventions Scientific Sessions.
A 24-hour multispecialty pulmonary embolism response service (PERS) surgeons was established at Emory University Hospital Midtown to improve outcomes in this patient population. The PERS team responds to calls from clinicians about patients presenting with pulmonary embolism (PE), reviews each case and discusses potential treatment options for patients at high risk for mortality or morbidity. The PERS team also developed treatment algorithms for this population, including systemic thrombolysis, catheter-directed thrombolysis, surgery and inferior vena cava filters, according to a press release.
“Treating patients with pulmonary embolism is complicated,” Neal Bhatia, MD, from Emory University School of Medicine in Atlanta, said in the release. “Part of the complexity in the management of pulmonary embolisms is due to the wide spectrum of clinical presentations. Physicians must decide among multiple treatment options but lack a standard approach and clear guidelines for higher-risk patients.”
One hundred forty-seven patients with PE were enrolled by the PERS team in a prospective registry from December 2012 to July 2014. Of those, 93 had submassive PE, nine had massive PE and the rest had low-risk PE. The mean age of the cohort was 64 years, 41% were men and 77% were black.
Higher-risk patients were treated more aggressively with catheter-directed or systemic thrombolytics. Sixty patients with submassive PE received initial treatment with anticoagulation only, 26 received catheter-directed thrombolytic infusion, four received systemic lytics and three received open embolectomy. Four patients originally assigned anticoagulation eventually received catheter-directed thrombolytic infusion and four were treated with systemic lytics, due to lack of improvement or hemodynamic deterioration.
Compared with patients who received initial anticoagulation, those assigned catheter-directed thrombolytic infusion had numerically lower rates of in-hospital mortality (8% of patients vs. 15%), 6-month mortality (12% vs. 28%) and recurrent PE (4% vs. 10%); a similar bleeding rate (16% vs. 15%) and a significantly higher rate of inferior vena cava filter retrieval (47% vs. 9%; P = .02), but longer length of stay in the ICU (2.8 days vs. 1.2 days; P < .01).
“Most of these patients may not have been treated as aggressively as we did because the guidelines are unclear and controversial,” Bhatia said in the release.
Bhatia and colleagues concluded that PERS implementation is feasible and results in more aggressive treatment with favorable outcomes.
“This analysis demonstrates the validity of collaborating with multiple specialties to improve diagnosis and outcomes for patients with pulmonary embolism,” Bhatia said in the release. “Such a team approach could change the odds for patients afflicted with this deadly condition.” – by Katie Kalvaitis
Reference:
Bhatia N, et al. Abstract 069.
Bhatia N, et al. Abstract 197. Both presented at: Society for Cardiovascular Angiography and Interventions Scientific Sessions; May 6-9, 2015; San Diego.
Disclosure: The researchers reports no relevant financial disclosures.