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Changes in treatment and outcomes after creation of a pulmonary embolism response team (PERT), a 10-year analysis

Journal of Thrombosis and Thrombolysis volume 47, pages 31–40 (2019)Cite this article

A Correction to this article was published on 30 November 2018

This article has been updated

Abstract

Multidisciplinary pulmonary embolism response teams (PERTs) are being implemented to improve care of patients with life-threatening PE. We sought to determine how the creation of PERT affects treatment and outcomes of patients with serious PE. A pre- and post-intervention study was performed using an interrupted time series design, to compare patients with PE before (2006–2012) and after (2012–2016) implementation of PERT at a university hospital. T-tests, Chi square tests and logistic regression were used to compare outcomes, and multivariable regression were used to adjust for differences in PE severity. Two-sided p-value < 0.05 was considered significant. For the interrupted time-series analysis, data was divided into mutually exclusive 6-month time periods (11 pre- and 7 post-PERT). To examine changes in treatment and outcomes associated with PERT, slopes and change points were compared pre- and post-PERT. Two-hundred and twelve pre-PERT and 228 post-PERT patients were analyzed. Patient demographics were generally similar, though pre-PERT, PE were more likely to be low-risk (37% vs. 19%) while post-PERT, PE were more likely to be submassive (32% vs. 49%). More patients underwent catheter directed therapy (1% vs. 14%, p = < 0.0001) or any advanced therapy (19 [9%] vs. 44 [19%], p = 0.002) post PERT. Interrupted time series analysis demonstrated that this increase was sudden and coincident with implementation of PERT, and most noticeable among patients with submassive PE. There were no differences in major bleeding or mortality pre- and post-PERT. While the use of advanced therapies, particularly catheter-directed therapies, increased after creation of PERT, especially among patients with submassive PE, there was no apparent increase in bleeding.

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Change history

  • 30 November 2018

    The original version of the article unfortunately contained an error in conflict of interest. This erratum is published with the correct conflict of interest.

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Acknowledgements

The authors thank Janet McClintic, MHA, for the administrative support she provided for this work. They thank the employed research staff of the Center for Vascular Emergencies for their assistance with data collection: Erin Deadmon and Nicholas Giordano. They also greatly appreciate the efforts of the clinical fellows who contributed to the care of pulmonary embolism response team patients and the collection of data used in this manuscript: Michael Nguyen Young, Rasha Fahad Al-Bawardy, Mazen Albaghdadi, and Jorge Borges. None were compensated for their contributions.

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Authors and Affiliations

  1. Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, USA

    Rachel Rosovsky

  2. Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA

    Yuchiao Chang

  3. Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA

    Kenneth Rosenfield & Ido Weinberg

  4. Division of Pulmonary and Critical Care, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA

    Richard Channick, Alison Witkin & Josanna Rodriguez-Lopez

  5. Department of Medicine, Newton Wellesley Hospital, Newton, MA, USA

    Michael R. Jaff

  6. Division of Cardiac Surgery, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA

    Thoralf Sundt

  7. Center for Vascular Emergencies, Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA

    Blair A. Parry, Savannah Harshbarger, Praveen Hariharan & Christopher Kabrhel

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  1. Rachel Rosovsky
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Contributions

RR had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Concept and design: Rosovsky, Chang, Kabrhel. Acquisition, analysis, or interpretation of data: Rosovsky, Chang, Rosenfield, Channick, Jaff, Weinberg, Sundt, Witkin, Rodriguez-Lopez, Parry, Harshbarger, Hariharan, Kabrhel. Drafting of the manuscript: Rosovsky, Chang and Kabrhel. Critical revision of the manuscript for important intellectual content: Rosovsky, Chang, Rosenfield, Channick, Jaff, Weinberg, Sundt, Witkin, Rodriguez-Lopez, Parry, Harshbarger, Hariharan, Kabrhel. Final approval of the manuscript: Rosovsky, Chang, Rosenfield, Channick, Jaff, Weinberg, Sundt, Witkin, Rodriguez-Lopez, Parry, Harshbarger, Hariharan, Kabrhel. Statistical analysis: Chang.

Corresponding author

Correspondence to Rachel Rosovsky.

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Conflict of interest

Chang, Channick, Weinberg, Witkin, Parry, Harshbarger, Hariharan declared that they have no conflict of interest. Rosovsky discloses the following relationships: grant recipient from Bristol Meyer Squibb and Janssen Pharmaceuticals; consultant to Bayer. Rosenfield discloses the following relationships: consultant to: Cardinal Health and SurModics; grants/contracts with Abbott Vascular, Atrium, Lutonix/BARD, and The Medicines Company; equity with Access Closure, Inc., and AngioDynamics/Vortex; personal compensation from Cook, HCRI, and The Medicines Company; board member with VIVA Physicians. Jaff discloses the following relationships: non compensated advisor to Abbott Vascular, Boston Scientific, Cordis, and Medtronic; equity with Vascular Therapies, PQ Bypass, Valiant Medical, and Primacea; board Member with VIVA Physicians (a 501 c 3 not-for-profit education and research). Sundt discloses the following relationship: consultant to Thrasos Therapeutics. Rodriguez-Lopez discloses the following relationships: Grant Support-Actelion pharmaceuticals. Consulting- Gilead pharmaceuticals. Kabrhel discloses the following relationships: consultant to Diagnostica Stago, Janssen Pharmaceuticals, Siemens, Pfizer, and Portola Pharmaceuticals; grant recipient from Diagnostica Stago, Siemens Healthcare, Janssen Pharmaceuticals, and Boehringer-Ingelheim.

Informed consent

Informed consent was not necessary or obtained as this was part of our program’s quality assurance/quality initiative and was a non interventional study.

Research involving human participants

All studies were approved by the Human Research Committee of Partners HealthCare Inc. (2012-P-002257, 2008-P-002001).

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Rosovsky, R., Chang, Y., Rosenfield, K. et al. Changes in treatment and outcomes after creation of a pulmonary embolism response team (PERT), a 10-year analysis. J Thromb Thrombolysis 47, 31–40 (2019). https://doi.org/10.1007/s11239-018-1737-8

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  • DOI: https://doi.org/10.1007/s11239-018-1737-8

Keywords

  • Pulmonary embolism
  • Pulmonary embolism response team
  • PERT
  • Treatment
  • Thrombolysis