Publication: Effect of Prognostic Guided Management of Patients With Acute Pulmonary Embolism According to the European Society of Cardiology Risk Stratification Model.
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Identifiers
Date
2022-04-12
Authors
Jimenez, David
Rodriguez, Carmen
Pintado, Beatriz
Perez, Andrea
Jara-Palomares, Luis
Lopez-Reyes, Raquel
Ruiz-Artacho, Pedro
Garcia-Ortega, Alberto
Bikdeli, Behnood
Lobo, Jose Luis
Advisors
Journal Title
Journal ISSN
Volume Title
Publisher
Frontiers Research Foundation
Abstract
Background: A recent trial showed that management driven by prognostic assessment was effective in reducing the length of stay (LOS) for acute stable pulmonary embolism (PE). The efficacy and safety of this strategy in each subgroup of risk stratification remains unknown. Methods : We conducted a post-hoc analysis of the randomized IPEP study to evaluate the effect of a management strategy guided by early use of a prognostic pathway in the low- and intermediate-high risk subgroups defined by the European Society of Cardiology (ESC) model. These subgroups were retrospectively identified in the control arm . The primary outcome was LOS. The secondary outcomes were 30-day clinical outcomes.Results: Of 249 patients assigned to the intervention group, 60 (24%) were classified as low-, and 30 (12%) as intermediate-high risk . Among 249 patients assigned to the control group , 66 (27%) were low-, and 13 (5%) intermediate-high risk . In the low- risk group, the mean LOS was 2.1 (±0.9) days in the intervention group and 5.3 (±2.9) days in the control group (P < 0.001). In this group, no significant differences were observed in 30-day readmissions (0% vs. 3.0%, respectively), all-cause (0% vs. 0%) and PE-related mortality rates (0% vs. 0%), or severe adverse events (0% vs. 1.5%). In the intermediate-high risk group, the mean LOS was 5.3 (±1.8) days in the intervention group and 6.5 (±2.5) days in the control group (P = 0.08). In this group, no significant differences were observed in 30-day readmissions (3.3% vs. 3.0%, respectively), all-cause (6.7% vs. 7.7%) and PE-related mortality rates (6.7% vs. 7.7%), or severe adverse events (16.7% vs. 15.4%).Conclusion: The use of a prognostic assessment and management pathway was effective in reducing the LOS for acute PE without comprising safety across subgroups of risk stratification.
Description
MeSH Terms
Humans
Prognosis
Control Groups
Retrospective Studies
Patient Readmission
Length of Stay
Cardiology
Risk Assessment
Prognosis
Control Groups
Retrospective Studies
Patient Readmission
Length of Stay
Cardiology
Risk Assessment
DeCS Terms
Riesgo
Mortalidad
Pacientes
Seguridad
Brazo
Embolia pulmonar
Eficacia
Cardiología
Métodos
Mortalidad
Pacientes
Seguridad
Brazo
Embolia pulmonar
Eficacia
Cardiología
Métodos
CIE Terms
Keywords
LOS, complications, mortality, prognosis, pulmonary embolism
Citation
Jiménez D, Rodríguez C, Pintado B, Pérez A, Jara-Palomares L, López-Reyes R, et al. Effect of Prognostic Guided Management of Patients With Acute Pulmonary Embolism According to the European Society of Cardiology Risk Stratification Model. Front Cardiovasc Med. 2022 Apr 12;9:872115.