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The value of sPESI for risk stratification in patients with pulmonary embolism

  • Phil Wells
  • W. Frank Peacock
  • Gregory J. Fermann
  • Craig I. Coleman
  • Li WangEmail author
  • Onur Baser
  • Jeff Schein
  • Concetta Crivera
Article

Abstract

Introduction

Various risk stratification methods exist for patients with pulmonary embolism (PE). We used the simplified Pulmonary Embolism Severity Index (sPESI) as a risk-stratification method to understand the Veterans Health Administration (VHA) PE population.

Materials and methods

Adult patients with ≥ 1 inpatient PE diagnosis (index date = discharge date) from October 2011–June 2015 as well as continuous enrollment for ≥ 12 months pre- and 3 months post-index date were included. We defined a sPESI score of 0 as low-risk (LRPE) and all others as high-risk (HRPE). Hospital-acquired complications (HACs) during the index hospitalization, 90-day follow-up PE-related outcomes, and health care utilization and costs were compared between HRPE and LRPE patients.

Results

Of 6746 PE patients, 95.4% were men, 67.7% were white, and 22.0% were African American; LRPE occurred in 28.4% and HRPE in 71.6%. Relative to HRPE patients, LRPE patients had lower Charlson Comorbidity Index scores (1.0 vs. 3.4, p < 0.0001) and other baseline comorbidities, fewer HACs (11.4% vs. 20.0%, p < 0.0001), less bacterial pneumonia (10.6% vs. 22.3%, p < 0.0001), and shorter average inpatient lengths of stay (8.8 vs. 11.2 days, p < 0.0001) during the index hospitalization. During follow-up, LRPE patients had fewer PE-related outcomes of recurrent venous thromboembolism (4.4% vs. 6.0%, p = 0.0077), major bleeding (1.2% vs. 1.9%, p = 0.0382), and death (3.7% vs. 16.2%, p < 0.0001). LRPE patients had fewer inpatient but higher outpatient visits per patient, and lower total health care costs ($12,021 vs. $16,911, p < 0.0001) than HRPE patients.

Conclusions

Using the sPESI score identifies a PE cohort with a lower clinical and economic burden.

Keywords

Pulmonary embolism Trauma Severity Index Cost of illness Veterans Health Administration 

Abbreviations

CCI

Charlson Comorbidity Index

CTA

Computed tomography angiography

DVT

Deep vein thrombosis

ECHO

Echocardiogram

ESC

European Society of Cardiology

HAC

Hospital-acquired complication

HRPE

High-risk pulmonary embolism

HRU

Health care resource utilization

ICD-9-CM

International Classification of Diseases, 9th Revision, Clinical Modification

IMPACT

In-hospital mortality for pulmonary embolism using claims data

LMWH

Low-molecular-weight heparin

LOS

Length of stay

LRPE

Low-risk pulmonary embolism

LV

Left ventricular

NOAC

Novel oral anticoagulant

PE

Pulmonary embolism

SAS

Statistical analysis software

SD

Standard deviation

sPESI

Simplified Pulmonary Embolism Severity Index

STD

Standardized difference

UFH

Unfractionated heparin

VHA

Veterans Health Administration

VQ

Lung ventilation/perfusion

VTE

Venous thromboembolism

Notes

Funding

This study was funded by Janssen Scientific Affairs, LLC.

Compliance with ethical standards

Conflict of interest

WFP has received grants from Abbott, Alere, Banyan, Cardiorentis, Janssen, Portola, Pfizer, Roche, and ZS Pharma; is a consultant to Alere, Beckman, Boehringer-Ingelheim, Cardiorentis, Instrument Labs, Janssen, Phillips, Portola, Prevencio, Singulex, The Medicine’s Company, and ZS Pharma; and also has ownership interests at the Comprehensive Research Associate LLC, Emergencies in Medicine LLC. CIC has received grant funding and consulting fees from Janssen Scientific Affairs, LLC, Raritan, NJ and Bayer Pharma AG, Berlin, Germany. PW receives speaker fees from Bayer Healthcare and Daiichi Sankyo, writing committee fees from Itreas, and grant support fees from Pfizer/BMS. GJF has received research support from Novartis, Siemens, Pfizer, Portola, and PCORI; has advised Janssen Scientific Affairs, LLC; and receives speaker fees from Janssen. CC and JS and are employees of Janssen Scientific Affairs. LW and OB are employees of STATinMED Research, which is a paid consultant to Janssen Scientific Affairs.

Supplementary material

11239_2019_1814_MOESM1_ESM.docx (123 kb)
Supplementary material 1 (DOCX 123 KB)

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.University of Ottawa and the Ottawa Hospital Research InstituteOttawaCanada
  2. 2.Baylor College of MedicineHoustonUSA
  3. 3.University of CincinnatiCincinnatiUSA
  4. 4.University of ConnecticutStorrsUSA
  5. 5.STATinMED Research, Analytic ResearchPlanoUSA
  6. 6.Internal MedicineUniversity of MichiganAnn ArborUSA
  7. 7.STATinMED Research, Health Economics & Outcomes ResearchNew YorkUSA
  8. 8.Janssen Scientific Affairs, LLCTitusvilleUSA

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