Management Appropriateness and Outcomes of Patients with Acute Pulmonary Embolism

DAVID JIMENEZ; BEHNOOD BIKDELI; DEISY BARRIOS; RAQUEL MORILLO; ROSA NIETO; INA GUERASSIMOVA; ALFONSO MURIEL; LUIS JARA-PALOMARES; LISA MOORES; VICTOR TAPSON; ROGER D. YUSEN; MANUEL MONREAL; FERNANDO VAZQUEZ

EUROPEAN RESPIRATORY JOURNAL

EUROPEAN RESPIRATORY SOC JOURNALS LTD

Lugar: Sheffield, UK; Año: 2018

0903-1936

Background: Studies have not well defined the impact of adherence to published guidelines on the outcomes of patients with acute pulmonary embolism (PE).Methods: In this prospective cohort study of patients admitted to a respiratory department (N = 2,096), we evaluated whether patients with PE had better outcomes if they were acutely managed according to international guidelines. Outcomes consisted of all-cause mortality, PE-related mortality, recurrent venous thromboembolism (VTE), and major bleeding events during the first month of follow-up after diagnosis.Results: Overall, 408 patients (20%; 95% confidence interval [CI], 18%-21%) did not receive guideline-adherent PE management. Patients receiving non-adherent management were significantly more likely to experience all-cause (adjusted odds ratio [OR], 2.39; 95% CI, 1.57-3.61) or PE-related (adjusted OR, 5.02; 95% CI, 2.42-10.42; P < 0.001) mortality during follow-up. Non-adherent management was also a significant independent predictor of recurrent VTE (OR, 2.19; 95% CI, 1.11-4.32; P = 0.03) and major bleeding (OR, 2.65; 95% CI, 1.66-4.24; P < 0.001). An external validation cohort of 34,380 patients with PE from the RIETE registry confirmed these findings.Conclusions: PE management that does not adhere to guidelines for indications related to anticoagulation, thrombolytics, and inferior vena cava filters is associated with patient outcomes.