Stefan Walen1, Bianca Katerberg2, Martijn F Boomsma3, Jan Willem K van den Berg2. 1. Department of Pulmonology, Isala, Dr. van Heesweg 2, 8025AB Zwolle, The Netherlands. Electronic address: s.walen@isala.nl. 2. Department of Pulmonology, Isala, Dr. van Heesweg 2, 8025AB Zwolle, The Netherlands. 3. Department of Radiology, Isala, Dr. van Heesweg 2,, 8025AB Zwolle, The Netherlands.
Abstract
BACKGROUND: Despite growing evidence on safe and feasible outpatient treatment for acute pulmonary embolism (PE), the majority of patients is still treated in an inpatient setting. This is probably due to a lack of clear guidelines on this subject. OBJECTIVES: To evaluate safety and patient reported outcome measures (PROM) on outpatient treatment of acute PE. METHODS: We conducted a prospective cohort study. 250 patients presenting with acute PE and Pulmonary Embolism Severity Index (PESI) class I or II were enrolled. Safety of outpatient treatment was assessed by measuring all-cause mortality, recurrent venous thromboembolism (VTE) and episodes of relevant bleeding, with a follow-up period of four weeks and six months. Additionally, PROM's on outpatient treatment were evaluated by repeatedly measuring VAS-scores for pain and dyspnea during the recovery, and by assessing the improvement in SF-36 scores between admission and after six months. RESULTS: We found an all-cause mortality rate of 0.4% (95% CI 0.07-2.23), rate of recurrent VTE of 0% (95% CI 0-1.51) and rate of relevant bleeding episodes of 6.4% (95% CI 3.98-10.14). VAS-scores improved significantly during the first 24-h after admission, and continued to improve significantly after five days of home treatment. SF-36 scores on 6 out of 8 domains improved significantly between admission and after six months. CONCLUSIONS: Our study shows that outpatient treatment is safe in selected low-risk patients based on their PESI score. Additionally, our data on patient reported outcome measures support the presumption of a good course of recovery during outpatient treatment.
BACKGROUND: Despite growing evidence on safe and feasible outpatient treatment for acute pulmonary embolism (PE), the majority of patients is still treated in an inpatient setting. This is probably due to a lack of clear guidelines on this subject. OBJECTIVES: To evaluate safety and patient reported outcome measures (PROM) on outpatient treatment of acute PE. METHODS: We conducted a prospective cohort study. 250 patients presenting with acute PE and Pulmonary Embolism Severity Index (PESI) class I or II were enrolled. Safety of outpatient treatment was assessed by measuring all-cause mortality, recurrent venous thromboembolism (VTE) and episodes of relevant bleeding, with a follow-up period of four weeks and six months. Additionally, PROM's on outpatient treatment were evaluated by repeatedly measuring VAS-scores for pain and dyspnea during the recovery, and by assessing the improvement in SF-36 scores between admission and after six months. RESULTS: We found an all-cause mortality rate of 0.4% (95% CI 0.07-2.23), rate of recurrent VTE of 0% (95% CI 0-1.51) and rate of relevant bleeding episodes of 6.4% (95% CI 3.98-10.14). VAS-scores improved significantly during the first 24-h after admission, and continued to improve significantly after five days of home treatment. SF-36 scores on 6 out of 8 domains improved significantly between admission and after six months. CONCLUSIONS: Our study shows that outpatient treatment is safe in selected low-risk patients based on their PESI score. Additionally, our data on patient reported outcome measures support the presumption of a good course of recovery during outpatient treatment.
Authors: David R Vinson; Erik R Hofmann; Elizabeth J Johnson; Suresh Rangarajan; Jie Huang; Dayna J Isaacs; Judy Shan; Karen L Wallace; Adina S Rauchwerger; Mary E Reed; Dustin G Mark Journal: J Gen Intern Med Date: 2022-01-12 Impact factor: 6.473
Authors: Paweł Latacz; Marian Simka; Pawel Brzegowy; Wojciech Serednicki; Ewa Konduracka; Wojciech Mrowiecki; Agnieszka Słowik; Bartłomiej Łasocha; Tomasz Mrowiecki; Tadeusz Popiela Journal: Wideochir Inne Tech Maloinwazyjne Date: 2018-05-16 Impact factor: 1.195