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Outpatient treatment safe for select patients with acute PE
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Favorable short-term outcomes of patients with pulmonary embolisms after hospital discharge suggest these patients can safely receive outpatient treatment, according to study results.
Acute PE has traditionally been treated in hospital settings during the initial management and initiation of an anticoagulant treatment regimen, according to study background. However, recent study results have suggested patients with low-risk PE could be safety treated as outpatients (Aujesky D, et al. Lancet. 2011;doi:10.1016/S0140-6736(11)60824-6).
Margaret C. Fang, MD, MPH, of the division of hospital medicine at the University of California, San Francisco, and colleagues sought to determine whether the study’s results could be replicated outside of the clinical trial setting.
The analysis included data from the Cardiovascular Research Network Venous Thromboembolism study, a collaboration of four geographically diverse health care delivery systems. Researchers identified 494 patients (median age, 61 years; range, 48-73) who were diagnosed with PE between 2004 and 2010 and who were discharged from hospital EDs with an anticoagulant prescription within 7 days. The cohort was 73.9% white and 49.2% (n = 243) female.
Hospital readmission within 30 days and death within 90 days served as the primary endpoints.
Researchers observed that 18.6% (n = 92) of patients with PE returned to the hospital within 30 days, and 7.9% (n = 39) of those patients were readmitted. Eleven patients (2.2%) had a primary diagnosis of hemorrhage during a subsequent hospital visit within 30 days.
Researchers noted mortality rates were low. No deaths were reported within the first 7 days after discharge, and only two deaths occurred after 90 days.
Patient discharge rates significantly increased during the study period. Approximately 11% of patients with PE were discharged in 2010 vs. 5.6% of patients with PE discharged in 2004 (P ˂ .001 for trend).
The investigators acknowledged limitations to their study, including the reliance on ICD-9 codes and pharmacy data to identify patients, as well as the lack of appropriate data to calculate a complete PE severity risk classification. The investigators also were unable to identify the specific reasons for patient disposition plans.
Still, mortality rates from this analysis are similar to those from previous clinical trials and suggest outpatient care can be implemented safety for select patients with acute PE, according to the researchers.
“Shifting appropriate patients to outpatient treatment may have benefits in terms of improved quality of life, enhanced physical and social functioning and reduced costs of medical care,” Fang and colleagues concluded. “We note that at least 23.4% of the patients in our study would not have been eligible for outpatient treatment in the clinical trial because they had higher PE Severity Index risk class. … Our study confirms that selected patients with PE can be treated as outpatients with favorable short-term outcomes.” – by Cameron Kelsall
Disclosure: One researcher reports a research grant from CSL Behring.
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