Impact of Multidisciplinary Pulmonary Embolism Response Team Availability on Management and Outcomes
Impact of Multidisciplinary Pulmonary Embolism Response Team Availability on Management and Outcomes
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DOI：
10.1016/j.amjcard.2019.07.043
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发表时间：
2019-11-01
影响因子：
2.8
通讯作者：
Bartholomew, John R.
中科院分区：
文献类型：
--
作者：
Chaudhury, Pulkit;Gadre, Shruti;Bartholomew, John R.
复杂肺栓塞（PE）患者的治疗策略经常因患者异质性、多种可用的治疗方式和缺乏共识指南而争论不休。虽然多学科肺栓塞反应小组（PERT）正在出现，以解决这种缺乏共识，其对患者结局的影响并不完全清楚。该分析旨在比较PERT可用性前后所有PE患者的结局。我们分析了在一家大型三级保健医院接受PERT之前和之后18个月内经计算机断层扫描诊断为急性PE的所有成人患者。在769例连续住院PE患者中，PERT时代患者的大出血或临床相关非大出血发生率较低（17.0% vs 8.3%，p = 0.002），较短的抗凝治疗时间（16.3小时vs 12.6小时，p = 0.009）和下腔静脉滤器使用减少（22.2% vs 16.4%，p = 0.004）。溶栓/基于导管的策略的使用有所增加，但未达到统计学显著性（p = 0.07）。30天/住院死亡率显著降低（8.5% vs 4.7%，p = 0.03）。这些结局差异在中危和高危患者中更为明显（死亡率10.0% vs 5.3%，p = 0.02）。多学科PERT的可用性与包括30天死亡率在内的结局改善相关。PE严重程度较高的患者似乎从PERT可用性中获益最多。(C)2019爱思唯尔公司All rights reserved.
Treatment strategies for complex patients with pulmonary embolism (PE) are often debated given patient heterogeneity, multitude of available treatment modalities, and lack of consensus guidelines. Although multidisciplinary Pulmonary Embolism Response Teams (PERT) are emerging to address this lack of consensus, their impact on patient outcomes is not entirely clear. This analysis was conducted to compare outcomes of all patients with PE before and after PERT availability. We analyzed all adult patients admitted with acute PE diagnosed on computed tomography scans in the 18 months before and after the institution of PERT at a large tertiary care hospital. Among 769 consecutive inpatients with PE, PERT era patients had lower rates of major or clinically relevant non-major bleeding (17.0% vs 8.3 %, p = 0.002), shorter time-to-therapeutic anticoagulation (16.3 hour vs 12.6 hour, p = 0.009) and decreased use of inferior vena cava filters (22.2% vs 16.4%, p = 0.004). There was an increase in the use of thrombolytics/catheter-based strategies, however, this did not achieve statistical significance (p = 0.07). There was a significant decrease in 30-day/inpatient mortality (8.5% vs 4.7 %, p = 0.03). These differences in outcomes were more pronounced in intermediate and high-risk patients (mortality 10.0% vs 5.3%, p = 0.02). The availability of multidisciplinary PERT was associated with improved outcomes including 30-day mortality. Patients with higher severity of PE seemed to derive most benefit from PERT availability. (C) 2019 Elsevier Inc. All rights reserved.