Interhospital Transfer for the Management of Acute Pulmonary Embolism - 04/04/22
, Sebastian E. Beyer, MD, MPH c, Colby Shanafelt, MD d, Christopher Kabrhel, MD, MPH e, Parth Rali, MD f, Belinda Rivera-Lebron, MD, MS g, Rachel Rosovsky, MD h, Charles B. Ross, MD i, Duane S. Pinto, MD, MPH b, Eric A. Secemsky, MD, MSc a, bAbstract |
Background |
There are increasing treatment options for the management of acute pulmonary embolism (PE), though many are only available at tertiary care centers. Patients with acute pulmonary embolism with high-risk features are often transferred for consideration of such therapies. There are limited data describing outcomes in patients transferred with acute pulmonary embolism.
Methods |
We evaluated patients with acute pulmonary embolism at our tertiary care center from August 2012 through August 2018 and compared clinical characteristics, pulmonary embolism features, management, and outcomes in those transferred for acute pulmonary embolism to those that were not transferred.
Results |
Of 2050 patients with pulmonary embolism included in the study, 432 (21.1%) were transferred from an outside hospital with a known diagnosis of pulmonary embolism. Patients transferred had a lower rate of malignancy (22.2% vs 33.3%; P < .001) and median Charlson comorbidity index (3 vs 4; P < .001). A higher percentage of patients transferred were classified as intermediate- or high-risk pulmonary embolism (62.5% vs 43.0%; P <.001) and more frequently received advanced therapy beyond anticoagulation alone (12.5% vs 3.2%, P < .001). Overall survival to discharge was similar between groups, though definite pulmonary embolism-related mortality was higher in the transferred group (38.5% vs 9.4%, P = .004).
Conclusion |
More than 1 in 5 patients treated for acute pulmonary embolism at a tertiary care center were transferred from an outside facility. Transferred patients had higher risk pulmonary embolism features, more often received advanced therapy, and had higher definite pulmonary embolism-related mortality. There are opportunities to further optimize outcomes of patients transferred for management of acute pulmonary embolism.
Le texte complet de cet article est disponible en PDF.Keywords : Interhospital transfer, Pulmonary embolism, Thrombolysis
| Funding: None. |
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| Conflicts of Interest: SEB, CS, CBR report none. BJC reports institutional research support from Bristol-Myers Squibb and consulting for Reliant Medical. CK reports research support from Grifols, Diagnostics Stago, and Janssen and consulting for Boston Scientific. PR reports consulting for Telling.Ai. BR-L reports consulting for Bayer, Janssen, and Bristol-Myers Squibb, and research support from Janssen. RR reports institutional research support from Janssen and Bristol-Myers Squibb and consulting for Janssen, Bristol-Myers Squibb, Dova, and Inari. DSP reports research support from Penumbra and consulting for Abbot Vascular, Abiomed, Boston Scientific, Teleflex, Terumo, Medtronic, and Newpulse CV. EAS reports research support to institution from NIH/NHLBI K23HL150290, Harvard Medical School's Shore Faculty Development Award, AstraZeneca, BD, Boston Scientific, Cook, CSI, Laminate Medical, Medtronic, and Philips and serving as a consultant or speaker for Abbott, Asahi, Bayer, BD, Boston Scientific, Cook, CSI, Inari, Janssen, Medtronic, Philips, and VentureMed. |
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| Authorship: All authors had access to the data and a role in writing this manuscript. |
Vol 135 - N° 4
P. 531-535 - avril 2022 Retour au numéro
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