Reduced mortality associated with pulmonary embolism response team consultation for intermediate and high-risk pulmonary embolism: a retrospective cohort study
Abstract Background The management of acute pulmonary embolism (PE) has become increasingly complex with the expansion of advanced therapeutic options, resulting in the development and widespread adoption of multidisciplinary Pulmonary Embolism Response Teams (PERTs). Much of the literature evaluati...
| Main Authors: | , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
BMC
2024-04-01
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| Series: | Thrombosis Journal |
| Online Access: | https://doi.org/10.1186/s12959-024-00605-8 |
| _version_ | 1797199248613179392 |
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| author | Tiffany A. Gardner Alexandra Fuher August Longino Eric M. Sink James Jurica Bryan Park Jonathan Lindquist Todd M. Bull Peter Hountras |
| author_facet | Tiffany A. Gardner Alexandra Fuher August Longino Eric M. Sink James Jurica Bryan Park Jonathan Lindquist Todd M. Bull Peter Hountras |
| author_sort | Tiffany A. Gardner |
| collection | DOAJ |
| description | Abstract Background The management of acute pulmonary embolism (PE) has become increasingly complex with the expansion of advanced therapeutic options, resulting in the development and widespread adoption of multidisciplinary Pulmonary Embolism Response Teams (PERTs). Much of the literature evaluating the impact of PERTs has been limited by pre- postimplementation study design, leading to confounding by changes in global practice patterns over time, and has yielded mixed results. To address this ambiguity, we conducted a retrospective cohort study to evaluate the impact of the distinct exposures of PERT availability and direct PERT consultation. Methods At a single tertiary center, we conducted propensity-matched analyses of hospitalized patients with intermediate or high-risk PE. To assess the impact of PERT availability, we evaluated the changes in 30-day mortality, hospital length of stay (HLOS), time to therapeutic anticoagulation (TAC), in-hospital bleeding complications, and use of advanced therapies between the two years preceding and following PERT implementation. To evaluate the impact of direct PERT consultation, we conducted the same analyses in the post-PERT era, comparing patients who did and did not receive PERT consultation. Results Six hundred eighty four patients were included, of which 315 were pre-PERT patients. Of the 367 postPERT patients, 201 received PERT consultation. For patients who received PERT consultation, we observed a significant reduction in 30-day mortality (5% vs 20%, OR 0.38, p = 0.0024), HLOS. (-5.4 days, p < 0.001), TAC (-0.25 h, p = 0.041), and in-hospital bleeding (OR 0.28, p = 0.011). These differences were not observed evaluating the impact of PERT presence in pre-vs postimplementation eras. Conclusions We observed a significant reduction in 30-day mortality, hospital LOS, TAC, and in-hospital bleeding complications for patients who received PERT consultation without an observed difference in these metrics when comparing the pre- vs post-implementation eras. This suggests the benefits stem from direct PERT involvement rather than the mere existence of PERT. Our data supports that PERT consultation may provide benefit to patients with acute intermediate or high-risk PE and can be achieved without a concomitant increase in advanced therapies. |
| first_indexed | 2024-04-24T07:12:44Z |
| format | Article |
| id | doaj.art-39c9a7ea0f82434896200432ab3c57cb |
| institution | Directory Open Access Journal |
| issn | 1477-9560 |
| language | English |
| last_indexed | 2024-04-24T07:12:44Z |
| publishDate | 2024-04-01 |
| publisher | BMC |
| record_format | Article |
| series | Thrombosis Journal |
| spelling | doaj.art-39c9a7ea0f82434896200432ab3c57cb2024-04-21T11:27:33ZengBMCThrombosis Journal1477-95602024-04-012211910.1186/s12959-024-00605-8Reduced mortality associated with pulmonary embolism response team consultation for intermediate and high-risk pulmonary embolism: a retrospective cohort studyTiffany A. Gardner0Alexandra Fuher1August Longino2Eric M. Sink3James Jurica4Bryan Park5Jonathan Lindquist6Todd M. Bull7Peter Hountras8Pulmonary and Critical Care Fellowship Program, Massachusetts General Hospital & Beth Israel Deaconess Medical CenterInternal Medicine Residency Program, Department of Medicine, University of Colorado Anschutz Medical CampusInternal Medicine Residency Program, Department of Medicine, University of Colorado Anschutz Medical CampusInternal Medicine Residency Program, Department of Medicine, University of Colorado Anschutz Medical CampusInternal Medicine Residency Program, Department of Medicine, University of Colorado Anschutz Medical CampusDivision of Pulmonary Sciences & Critical Care, Pulmonary Vascular Disease Center, Department of Medicine, University of Colorado Anschutz Medical CampusDivision of Vascular and Interventional Radiology, Department of Radiology, University of Colorado Anschutz Medical CampusDivision of Pulmonary Sciences & Critical Care, Pulmonary Vascular Disease Center, Department of Medicine, University of Colorado Anschutz Medical CampusDivision of Pulmonary Sciences & Critical Care, Pulmonary Vascular Disease Center, Department of Medicine, University of Colorado Anschutz Medical CampusAbstract Background The management of acute pulmonary embolism (PE) has become increasingly complex with the expansion of advanced therapeutic options, resulting in the development and widespread adoption of multidisciplinary Pulmonary Embolism Response Teams (PERTs). Much of the literature evaluating the impact of PERTs has been limited by pre- postimplementation study design, leading to confounding by changes in global practice patterns over time, and has yielded mixed results. To address this ambiguity, we conducted a retrospective cohort study to evaluate the impact of the distinct exposures of PERT availability and direct PERT consultation. Methods At a single tertiary center, we conducted propensity-matched analyses of hospitalized patients with intermediate or high-risk PE. To assess the impact of PERT availability, we evaluated the changes in 30-day mortality, hospital length of stay (HLOS), time to therapeutic anticoagulation (TAC), in-hospital bleeding complications, and use of advanced therapies between the two years preceding and following PERT implementation. To evaluate the impact of direct PERT consultation, we conducted the same analyses in the post-PERT era, comparing patients who did and did not receive PERT consultation. Results Six hundred eighty four patients were included, of which 315 were pre-PERT patients. Of the 367 postPERT patients, 201 received PERT consultation. For patients who received PERT consultation, we observed a significant reduction in 30-day mortality (5% vs 20%, OR 0.38, p = 0.0024), HLOS. (-5.4 days, p < 0.001), TAC (-0.25 h, p = 0.041), and in-hospital bleeding (OR 0.28, p = 0.011). These differences were not observed evaluating the impact of PERT presence in pre-vs postimplementation eras. Conclusions We observed a significant reduction in 30-day mortality, hospital LOS, TAC, and in-hospital bleeding complications for patients who received PERT consultation without an observed difference in these metrics when comparing the pre- vs post-implementation eras. This suggests the benefits stem from direct PERT involvement rather than the mere existence of PERT. Our data supports that PERT consultation may provide benefit to patients with acute intermediate or high-risk PE and can be achieved without a concomitant increase in advanced therapies.https://doi.org/10.1186/s12959-024-00605-8 |
| spellingShingle | Tiffany A. Gardner Alexandra Fuher August Longino Eric M. Sink James Jurica Bryan Park Jonathan Lindquist Todd M. Bull Peter Hountras Reduced mortality associated with pulmonary embolism response team consultation for intermediate and high-risk pulmonary embolism: a retrospective cohort study Thrombosis Journal |
| title | Reduced mortality associated with pulmonary embolism response team consultation for intermediate and high-risk pulmonary embolism: a retrospective cohort study |
| title_full | Reduced mortality associated with pulmonary embolism response team consultation for intermediate and high-risk pulmonary embolism: a retrospective cohort study |
| title_fullStr | Reduced mortality associated with pulmonary embolism response team consultation for intermediate and high-risk pulmonary embolism: a retrospective cohort study |
| title_full_unstemmed | Reduced mortality associated with pulmonary embolism response team consultation for intermediate and high-risk pulmonary embolism: a retrospective cohort study |
| title_short | Reduced mortality associated with pulmonary embolism response team consultation for intermediate and high-risk pulmonary embolism: a retrospective cohort study |
| title_sort | reduced mortality associated with pulmonary embolism response team consultation for intermediate and high risk pulmonary embolism a retrospective cohort study |
| url | https://doi.org/10.1186/s12959-024-00605-8 |
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