Current practice patterns of outpatient management of acute pulmonary embolism: A post-hoc analysis of the YEARS study
Hendriks, Stephan V.; Bavalia, Roisin; van Bemmel, Thomas; Bistervels, Ingrid M.; Eijsvogel, Michiel; Faber, Laura M.; Fogteloo, Jaap; Hofstee, Herman M.A.; van der Hulle, Tom; Iglesias del Sol, Antonio; Kruip, Marieke J.H.A.; Mairuhu, Albert T.A.; Middeldorp, Saskia; Nijkeuter, Mathilde; Huisman, Menno V.; Klok, Frederikus A.; the YEARS investigators
(2020) Thrombosis Research, volume 193, pp. 60 - 65
(Article)
Abstract
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
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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.
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Keywords: Acute pulmonary embolism, Ambulatory care, Daily practice, Outpatients, Readmissions, Hematology, Journal Article
ISSN: 0049-3848
Publisher: Elsevier Limited
Note: Funding Information: None. All authors have contributed significantly to this manuscript and take responsibility for the analyses. Stephan V. Hendriks: Contributed to concept and design of the study, analyzed and interpreted the data, and drafted the manuscript Menno V. Huisman: Contributed to concept and design of the study, analyzed and interpreted the data, reviewed the manuscript and provided important intellectual content Roisin Bavalia: reviewed the manuscript, analyzed the data and provided important intellectual content Thomas van Bemmel: reviewed the manuscript and provided important intellectual content Ingrid M. Bistervels: reviewed the manuscript and provided important intellectual content Michiel Eijsvogel: reviewed the manuscript and provided important intellectual content Laura M. Faber: reviewed the manuscript and provided important intellectual content Jaap Fogteloo: reviewed the manuscript and provided important intellectual content Herman M.A. Hofstee: reviewed the manuscript and provided important intellectual content Tom van der Hulle: reviewed the manuscript and provided important intellectual content Antonio Iglesias del Sol: reviewed the manuscript and provided important intellectual content Marieke J.H.A. Kruip: reviewed the manuscript and provided important intellectual content Saskia Middeldorp: reviewed the manuscript and provided important intellectual content Albert T.A. Mairuhu: reviewed the manuscript and provided important intellectual content. Mathilde Nijkeuter: reviewed the manuscript and provided important intellectual content. Frederikus A. Klok: Wrote the manuscript, contributed to concept and design of the study and analyzed and interpreted the data., Frederikus Klok reports research grants from Bayer, Bristol-Myers Squibb, Boehringer-Ingelheim, Daiichi-Sankyo, MSD and Actelion, the Dutch Heart foundation and the Netherlands Thrombosis Foundation, outside the submitted work. Menno Huisman reports grants from ZonMW Dutch Healthcare Fund, grants and personal fees from Boehringer Ingelheim, grants and personal fees from Pfizer-BMS, grants and personal fees from Bayer Health Care, grants from Aspen, grants and personal fees from Daiichi-Sankyo, outside the submitted work. Marieke Kruip reports research grants from ZonMW Dutch Healthcare Fund, Bayer, Boehringer-Ingelheim, Daiichi-Sankyo, Pfizer and personal fees from Bayer, outside the submitted work. Dr. Middeldorp reports grants and personal fees from Aspen, grants and personal fees from Daiichi Sankyo, grants and personal fees from Bayer, personal fees from BMS-Pfizer, personal fees from Boehringer-Ingelheim, personal fees from Portola, personal fees from Sanofi, outside the submitted work. All other authors have no disclosures. Funding Information: Marieke Kruip reports research grants from ZonMW Dutch Healthcare Fund, Bayer, Boehringer-Ingelheim, Daiichi-Sankyo, Pfizer and personal fees from Bayer, outside the submitted work. Publisher Copyright: © 2020 The Authors
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