Y M Ende-Verhaar1, W B van den Hout2, H J Bogaard3, L J Meijboom4, M V Huisman1, P Symersky5, A Vonk-Noordegraaf3, F A Klok1. 1. Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands. 2. Department of Medical statistics and Bio-informatics, Leiden University Medical Center, Leiden, the Netherlands. 3. Department of Pulmonology, VU University Medical Center, Amsterdam, the Netherlands. 4. Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, the Netherlands. 5. Department of Cardiac Surgery, VU University Medical Center, Amsterdam, the Netherlands.
Abstract
Essentials Diagnostic delay of chronic thromboembolic pulmonary hypertension (CTEPH) is long. We explored healthcare utilisation of patients diagnosed with CTEPH after pulmonary embolism. A large number of physicians were consulted and test results were not always interpreted correctly. Better education and higher awareness of CTEPH may lead to faster diagnosis. SUMMARY: Background The median diagnostic delay of chronic thromboembolic pulmonary hypertension (CTEPH) is 14 months, which may affect prognosis. We aimed to explore the healthcare utilization of patients diagnosed with CTEPH after acute pulmonary embolism (PE), and to identify the causes of diagnostic delay. Methods We collected all data on patient symptoms, medical specialist referrals and ordered diagnostic tests to reconstruct the clinical pathways of 40 patients referred to the VU University Medical Center Amsterdam (VUMC, the Netherlands) for CTEPH treatment. Diagnostic delay was defined as the time between first symptom onset and referral to the VUMC. Correlations of patient-specific characteristics and diagnostic delay were evaluated. Results Patients consulted four (median) different physicians for a median of 13 (interquartile range [IQR] 10-18) consultations before the correct diagnosis was made. The median diagnostic delay was 21 months (IQR 12-49 months). Echocardiographic results suggestive of CTEPH were not always followed by an adequate work-up; most patients were not subjected to ventilation/perfusion scanning. Prior cardiopulmonary comorbidity and recurrent venous thromboembolism were predictors of a longer delay. Conclusion Healthcare utilization in patients before their final CTEPH diagnosis was far from optimal, contributing to a considerable diagnostic delay. Better education and higher awareness of CTEPH among PE caretakers may lead to faster diagnosis.
Essentials Diagnostic delay of chronic thromboembolic pulmonary hypertension (CTEPH) is long. We explored healthcare utilisation of patients diagnosed with CTEPH after pulmonary embolism. A large number of physicians were consulted and test results were not always interpreted correctly. Better education and higher awareness of CTEPH may lead to faster diagnosis. SUMMARY: Background The median diagnostic delay of chronic thromboembolic pulmonary hypertension (CTEPH) is 14 months, which may affect prognosis. We aimed to explore the healthcare utilization of patients diagnosed with CTEPH after acute pulmonary embolism (PE), and to identify the causes of diagnostic delay. Methods We collected all data on patient symptoms, medical specialist referrals and ordered diagnostic tests to reconstruct the clinical pathways of 40 patients referred to the VU University Medical Center Amsterdam (VUMC, the Netherlands) for CTEPH treatment. Diagnostic delay was defined as the time between first symptom onset and referral to the VUMC. Correlations of patient-specific characteristics and diagnostic delay were evaluated. Results Patients consulted four (median) different physicians for a median of 13 (interquartile range [IQR] 10-18) consultations before the correct diagnosis was made. The median diagnostic delay was 21 months (IQR 12-49 months). Echocardiographic results suggestive of CTEPH were not always followed by an adequate work-up; most patients were not subjected to ventilation/perfusion scanning. Prior cardiopulmonary comorbidity and recurrent venous thromboembolism were predictors of a longer delay. Conclusion Healthcare utilization in patients before their final CTEPH diagnosis was far from optimal, contributing to a considerable diagnostic delay. Better education and higher awareness of CTEPH among PE caretakers may lead to faster diagnosis.
Authors: Gudula J A M Boon; Nienke van Rein; Harm Jan Bogaard; Yvonne M Ende-Verhaar; Menno V Huisman; Lucia J M Kroft; Felix J M van der Meer; Lilian J Meijboom; Petr Symersky; Anton Vonk Noordegraaf; Frederikus A Klok Journal: PLoS One Date: 2020-04-28 Impact factor: 3.240
Authors: Gudula J A M Boon; Wilbert B van den Hout; Stefano Barco; Harm Jan Bogaard; Marion Delcroix; Menno V Huisman; Stavros V Konstantinides; Lilian J Meijboom; Esther J Nossent; Petr Symersky; Anton Vonk Noordegraaf; Frederikus A Klok Journal: ERJ Open Res Date: 2021-09-06
Authors: Olga Dzikowska-Diduch; Katarzyna Kurnicka; Barbara Lichodziejewska; Olga Zdończyk; Dominika Dąbrowska; Marek Roik; Szymon Pacho; Maksymilian Bielecki; Piotr Pruszczyk Journal: J Clin Med Date: 2022-02-18 Impact factor: 4.241