Stephan V Hendriks1, Roisin Bavalia2, Thomas van Bemmel3, Ingrid M Bistervels4, Michiel Eijsvogel5, Laura M Faber6, Jaap Fogteloo7, Herman M A Hofstee8, Tom van der Hulle9, Antonio Iglesias Del Sol10, Marieke J H A Kruip11, Albert T A Mairuhu12, Saskia Middeldorp2, Mathilde Nijkeuter13, Menno V Huisman9, Frederikus A Klok9. 1. Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands; Department of Internal Medicine, Haga Teaching Hospital, The Hague, the Netherlands. Electronic address: s.v.hendriks@lumc.nl. 2. Department of Vascular Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands. 3. Department of Internal Medicine, Gelre Hospital, Apeldoorn, the Netherlands. 4. Department of Vascular Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands; Department of Internal Medicine, Flevoziekenhuis, Almere, the Netherlands. 5. Department of Pulmonary Medicine, Medisch Spectrum Twente, Enschede, the Netherlands. 6. Department of Pulmonary Medicine, Rode Kruis Hospital, Beverwijk, the Netherlands. 7. Department of Acute Internal Medicine, Leiden University Medical Center, Leiden, the Netherlands. 8. Department of Internal Medicine, HMC Westeinde/Bronono, The Hague, the Netherlands. 9. Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands. 10. Department of Internal Medicine, Alrijne Hospital, Leiderdorp, the Netherlands. 11. Department of Haematology, Erasmus University Medical center, Rotterdam, the Netherlands. 12. Department of Internal Medicine, Haga Teaching Hospital, The Hague, the Netherlands. 13. Department of Internal Medicine, University Medical Center Utrecht, Utrecht, the Netherlands.
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 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.
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 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.
Authors: Pierre-Marie Roy; Andrea Penaloza; Olivier Hugli; Frederikus A Klok; Armelle Arnoux; Antoine Elias; Francis Couturaud; Luc-Marie Joly; Raphaëlle Lopez; Laura M Faber; Marie Daoud-Elias; Benjamin Planquette; Jérôme Bokobza; Damien Viglino; Jeannot Schmidt; Henry Juchet; Isabelle Mahe; Frits Mulder; Magali Bartiaux; Rosen Cren; Thomas Moumneh; Isabelle Quere; Nicolas Falvo; Karine Montaclair; Delphine Douillet; Charlotte Steinier; Stephan V Hendriks; Ygal Benhamou; Tali-Anne Szwebel; Gilles Pernod; Nicolas Dublanchet; François-Xavier Lapebie; Nicolas Javaud; Alexandre Ghuysen; Mustapha Sebbane; Gilles Chatellier; Guy Meyer; David Jimenez; Menno V Huisman; Olivier Sanchez Journal: Eur Heart J Date: 2021-08-31 Impact factor: 29.983