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Trends in management and outcomes of pulmonary embolism with a multidisciplinary response team
Romain Chopard1,2,3, Umberto Campia4, Lucas Morin5
1Department of Cardiology, University Hospital Jean Minjoz, Besançon, France.
Insights
Multidisciplinary pulmonary embolism (PE) response teams coincided with improved outcomes. Major bleeding, mortality, and readmission rates decreased over five years, despite increased PE acuity.
Area of Science:
- Cardiology
- Pulmonology
- Healthcare Management
Background:
- Multidisciplinary pulmonary embolism (PE) response teams are increasingly adopted for complex acute PE management.
- These teams offer a framework to analyze trends in PE therapy and patient outcomes.
Purpose of the Study:
- To describe temporal trends in PE management and outcomes after implementing a multidisciplinary PE response team.
- To assess changes in a composite endpoint of death, bleeding, recurrent VTE, and readmission over a 5-year period.
Main Methods:
- A 5-year retrospective analysis of consecutive patients managed by a multidisciplinary PE response team.
- Examination of temporal trends in PE management strategies and a composite primary endpoint at 30 days and 6 months.
- Analysis included 425 patients from 2015 to 2019, with 406 having complete follow-up.
Main Results:
- An increase in PE acuity and use of systemic thrombolysis was observed.
- The 30-day composite endpoint decreased from 16.3% in 2015 to 7.1% in 2019, primarily due to reduced major bleeding.
- The 6-month composite endpoint showed a significant decrease in adjusted rate ratio per year (0.37), driven by lower all-cause mortality.
Conclusions:
- Temporal changes in clinical presentation, treatment, and outcomes for acute PE were observed.
- These changes occurred in parallel with the multidisciplinary team's implementation, though causality is not definitively established.
- Significant reductions in major bleeding, mortality, and readmission rates were achieved despite increasing PE risk category over time.
Abstract:
Multidisciplinary pulmonary embolism (PE) response teams have garnered widespread adoption given the complexities of managing acute PE and provide a platform for assessment of trends in therapy and outcomes. We describe temporal trends in PE management and outcomes following the deployment of such a team. All consecutive patients managed by our multidisciplinary PE response team activated by the Emergency Department were included over a 5-year calendar period. We examined temporal trends in management and rates of a composite primary endpoint (all-cause-death, major bleeding, recurrent venous thromboembolism, and readmission) at 30 days and 6 months. We assessed 425 patients between 2015 and 2019. We observed an increase in PE acuity and use of systemic thrombolysis. The primary endpoint at 30 days decreased from 16.3% in 2015 to 7.1% in 2019 (adjusted rate ratio per period, 0.63; 95%CI, 0.47-0.84), driven by a decrease in the adjusted rate of major bleeding. Among 406 patients with complete follow-up, the adjusted rate ratio per year for the primary outcome at 6 months was 0.37 (95%CI, 0.19-0.71), driven by a decrease in all-cause mortality. We observed evidence of temporal changes in clinical presentation, therapeutic strategies, and outcomes for acute PE, in parallel to, but not necessarily because of, the implementation of a multidisciplinary response team. Over time, major bleeding, mortality and readmission rates decreased, despite an increase in PE risk category.
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