Treatment strategies for complex patients with pulmonary embolism (PE) are often debated
given patient heterogeneity, multitude of available treatment modalities, and lack
of consensus guidelines. Although multidisciplinary Pulmonary Embolism Response Teams
(PERT) are emerging to address this lack of consensus, their impact on patient outcomes
is not entirely clear. This analysis was conducted to compare outcomes of all patients
with PE before and after PERT availability. We analyzed all adult patients admitted
with acute PE diagnosed on computed tomography scans in the 18 months before and after
the institution of PERT at a large tertiary care hospital. Among 769 consecutive inpatients
with PE, PERT era patients had lower rates of major or clinically relevant nonmajor
bleeding (17.0% vs 8.3%, p = 0.002), shorter time-to-therapeutic anticoagulation (16.3
hour vs 12.6 hour, p = 0.009) and decreased use of inferior vena cava filters (22.2%
vs 16.4%, p = 0.004). There was an increase in the use of thrombolytics/catheter-based
strategies, however, this did not achieve statistical significance (p = 0.07). There
was a significant decrease in 30-day/inpatient mortality (8.5% vs 4.7%, p = 0.03).
These differences in outcomes were more pronounced in intermediate and high-risk patients
(mortality 10.0% vs 5.3%, p = 0.02). The availability of multidisciplinary PERT was
associated with improved outcomes including 30-day mortality. Patients with higher
severity of PE seemed to derive most benefit from PERT availability.
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Article info
Publication history
Published online: August 07, 2019
Received in revised form:
July 16,
2019
Received:
March 25,
2019
Footnotes
Institution: The Cleveland Clinic.
Funding: None.
Identification
Copyright
© 2019 Elsevier Inc. All rights reserved.
