Two tests have proved equally useful at deciding which patients with acute pulmonary embolism can be managed at home, a European conference has heard.
Haemodynamically stable acute pulmonary embolism patients are often kept in hospital, due to the risk of bleeding following the administration of anticoagulants.
Recently, researchers have investigated the possibility of home treatment for certain patients. Prof Pierre-Marie Roy of the University Hospital of Angers, France, and colleagues set out to discover the optimal referral strategies and eligibility criteria for outpatient care.
The team compared the predictive value of two tests, the sPESI score and the Hestia criteria. The sPESI, or simplified Pulmonary Embolism Severity Index, is recommended by European guidelines. The Hestia criteria are recommended in American guidelines and are considered more pragmatic.
This study compared the safety of the two. It was based on 1,974 patients at 26 hospitals in Europe, who were randomised to be assessed by either sPESI or Hestia. Patients were eligible for home care if either their sPESI score was 0, or if all 11 Hestia criteria were negative. With both tests, the doctor in charge of the patient’s care could overrule the decision.
The primary outcome in the trial was a combination of recurrent venous thromboembolism, major bleeding, and death from any cause within 30 days. The Hestia test was found to be non-inferior to sPESI: the primary outcome occurred in 3.8% of the Hestia group and 3.6% of the sPESI group.
A greater proportion of patients were eligible for home care using sPESI (48.4%) compared to Hestia (39.4%), but sPESI was overruled by doctors more often. In all, the 38.4% in the Hestia group and 36.6% in the sPESI group were discharged within 24 hours for home treatment, a difference which was not statistically significant. All patients managed from home had low rates of complications.
Findings were presented at the European Society of Cardiology Congress 2020, held online.
Prof Roy said: “The pragmatic Hestia method was at least as safe as the sPESI score for triaging haemodynamically stable pulmonary embolism patients for outpatient care.
“These results support outpatient management of acute pulmonary embolism patients using either the Hestia method or the sPESI score with the option for physicians to override the decision. In hospitals organised for outpatient management, both triaging strategies enable more than a third of pulmonary embolism patients to be managed at home with a low rate of complications.”
Hospitalization or outpatient management of patients with acute pulmonary embolism - HESTIA versus simplified PESI: an international multicentre randomized controlled study (HOME-PE study). Presented at European Society of Cardiology Congress 2020 on Monday 31 August 2020
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