TY - JOUR
T1 - Safety of treating acute pulmonary embolism at home
T2 - an individual patient data meta-analysis
AU - Luijten, Dieuwke
AU - Douillet, Delphine
AU - Luijken, Kim
AU - Tromeur, Cecile
AU - Penaloza, Andrea
AU - Hugli, Olivier
AU - Aujesky, Drahomir
AU - Barco, Stefano
AU - Bledsoe, Joseph R.
AU - Chang, Kyle E.
AU - Couturaud, Francis
AU - den Exter, Paul L.
AU - Font, Carme
AU - Huisman, Menno V.
AU - Jimenez, David
AU - Kabrhel, Christopher
AU - Kline, Jeffrey A.
AU - Konstantinides, Stavros
AU - van Mens, Thijs
AU - Otero, Remedios
AU - Peacock, W. Frank
AU - Sanchez, Olivier
AU - Stubblefield, William B.
AU - Valerio, Luca
AU - Vinson, David R.
AU - Wells, Philip
AU - van Smeden, Maarten
AU - Roy, Pierre Marie
AU - Klok, Frederikus A.
N1 - Publisher Copyright:
© The Author(s) 2024.
PY - 2024/8/21
Y1 - 2024/8/21
N2 - Background and Aims Home treatment is considered safe in acute pulmonary embolism (PE) patients selected by a validated triage tool (e.g. simplified PE severity index score or Hestia rule), but there is uncertainty regarding the applicability in underrepresented subgroups. The aim was to evaluate the safety of home treatment by performing an individual patient-level data meta-analysis. Methods Ten prospective cohort studies or randomized controlled trials were identified in a systematic search, totalling 2694 PE patients treated at home (discharged within 24 h) and identified by a predefined triage tool. The 14- and 30-day incidences of all-cause mortality and adverse events (combined endpoint of recurrent venous thromboembolism, major bleeding, and/or all-cause mortality) were evaluated. The relative risk (RR) for 14- and 30-day mortalities and adverse events is calculated in subgroups using a random effects model. Results The 14- and 30-day mortalities were 0.11% [95% confidence interval (CI) 0.0-0.24, I2 = 0) and 0.30% (95% CI 0.09-0.51, I2 = 0). The 14- and 30-day incidences of adverse events were 0.56% (95% CI 0.28-0.84, I2 = 0) and 1.2% (95% CI 0.79- 1.6, I2 = 0). Cancer was associated with increased 30-day mortality [RR 4.9; 95% prediction interval (PI) 2.7-9.1; I2 = 0]. Pre-existing cardiopulmonary disease, abnormal troponin, and abnormal (N-terminal pro-)B-type natriuretic peptide [(NT-pro)BNP] at presentation were associated with an increased incidence of 14-day adverse events [RR 3.5 (95% PI 1.5-7.9, I2 = 0), 2.5 (95% PI 1.3-4.9, I2 = 0), and 3.9 (95% PI 1.6-9.8, I2 = 0), respectively], but not mortality. At 30 days, cancer, abnormal troponin, and abnormal (NT-pro)BNP were associated with an increased incidence of adverse events [RR 2.7 (95% PI 1.4-5.2, I2 = 0), 2.9 (95% PI 1.5-5.7, I2 = 0), and 3.3 (95% PI 1.6-7.1, I2 = 0), respectively]. Conclusions The incidence of adverse events in home-treated PE patients, selected by a validated triage tool, was very low. Patients with cancer had a three- to five-fold higher incidence of adverse events and death. Patients with increased troponin or (NT-pro) BNP had a three-fold higher risk of adverse events, driven by recurrent venous thromboembolism and bleeding.
AB - Background and Aims Home treatment is considered safe in acute pulmonary embolism (PE) patients selected by a validated triage tool (e.g. simplified PE severity index score or Hestia rule), but there is uncertainty regarding the applicability in underrepresented subgroups. The aim was to evaluate the safety of home treatment by performing an individual patient-level data meta-analysis. Methods Ten prospective cohort studies or randomized controlled trials were identified in a systematic search, totalling 2694 PE patients treated at home (discharged within 24 h) and identified by a predefined triage tool. The 14- and 30-day incidences of all-cause mortality and adverse events (combined endpoint of recurrent venous thromboembolism, major bleeding, and/or all-cause mortality) were evaluated. The relative risk (RR) for 14- and 30-day mortalities and adverse events is calculated in subgroups using a random effects model. Results The 14- and 30-day mortalities were 0.11% [95% confidence interval (CI) 0.0-0.24, I2 = 0) and 0.30% (95% CI 0.09-0.51, I2 = 0). The 14- and 30-day incidences of adverse events were 0.56% (95% CI 0.28-0.84, I2 = 0) and 1.2% (95% CI 0.79- 1.6, I2 = 0). Cancer was associated with increased 30-day mortality [RR 4.9; 95% prediction interval (PI) 2.7-9.1; I2 = 0]. Pre-existing cardiopulmonary disease, abnormal troponin, and abnormal (N-terminal pro-)B-type natriuretic peptide [(NT-pro)BNP] at presentation were associated with an increased incidence of 14-day adverse events [RR 3.5 (95% PI 1.5-7.9, I2 = 0), 2.5 (95% PI 1.3-4.9, I2 = 0), and 3.9 (95% PI 1.6-9.8, I2 = 0), respectively], but not mortality. At 30 days, cancer, abnormal troponin, and abnormal (NT-pro)BNP were associated with an increased incidence of adverse events [RR 2.7 (95% PI 1.4-5.2, I2 = 0), 2.9 (95% PI 1.5-5.7, I2 = 0), and 3.3 (95% PI 1.6-7.1, I2 = 0), respectively]. Conclusions The incidence of adverse events in home-treated PE patients, selected by a validated triage tool, was very low. Patients with cancer had a three- to five-fold higher incidence of adverse events and death. Patients with increased troponin or (NT-pro) BNP had a three-fold higher risk of adverse events, driven by recurrent venous thromboembolism and bleeding.
KW - Clinical decision-making
KW - Early discharge
KW - Emergency care
KW - Outpatient care
KW - Pulmonary embolism
UR - http://www.scopus.com/inward/record.url?scp=85201922678&partnerID=8YFLogxK
U2 - 10.1093/eurheartj/ehae378
DO - 10.1093/eurheartj/ehae378
M3 - Article
C2 - 38993086
AN - SCOPUS:85201922678
SN - 0195-668X
VL - 45
SP - 2933
EP - 2950
JO - European heart journal
JF - European heart journal
IS - 32
ER -