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Trends in management and outcomes of pulmonary embolism with a multidisciplinary response team

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Abstract

Multidisciplinary pulmonary embolism (PE) response teams have garnered widespread adoption given the complexities of managing acute PE and provide a platform for assessment of trends in therapy and outcomes. We describe temporal trends in PE management and outcomes following the deployment of such a team. All consecutive patients managed by our multidisciplinary PE response team activated by the Emergency Department were included over a 5-year calendar period. We examined temporal trends in management and rates of a composite primary endpoint (all-cause-death, major bleeding, recurrent venous thromboembolism, and readmission) at 30 days and 6 months. We assessed 425 patients between 2015 and 2019. We observed an increase in PE acuity and use of systemic thrombolysis. The primary endpoint at 30 days decreased from 16.3% in 2015 to 7.1% in 2019 (adjusted rate ratio per period, 0.63; 95%CI, 0.47–0.84), driven by a decrease in the adjusted rate of major bleeding. Among 406 patients with complete follow-up, the adjusted rate ratio per year for the primary outcome at 6 months was 0.37 (95%CI, 0.19–0.71), driven by a decrease in all-cause mortality. We observed evidence of temporal changes in clinical presentation, therapeutic strategies, and outcomes for acute PE, in parallel to, but not necessarily because of, the implementation of a multidisciplinary response team. Over time, major bleeding, mortality and readmission rates decreased, despite an increase in PE risk category.

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Author information

Authors and Affiliations

  1. Department of Cardiology, University Hospital Jean Minjoz, Besançon, France

    Romain Chopard

  2. EA3920, University of Burgundy Franche-Comté, Besançon, France

    Romain Chopard

  3. F-CRIN, INNOVTE Network, Saint-Etienne, France

    Romain Chopard

  4. Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, USA

    Umberto Campia, Karola S. Jering, Zaid I. Almarzooq, Julia Elizabeth Snyder, Samantha Rizzo, Samuel Z. Goldhaber & Gregory Piazza

  5. Inserm CIC 1431, Clinical Investigation Unit, University Hospital Jean Minjoz, Besançon, France

    Lucas Morin

  6. Division of Pulmonary and Critical Care, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA

    Aaron B. Waxman

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  1. Romain Chopard
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  2. Umberto Campia
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Contributions

Study conception and design: RC, UC, GP; data collection: RC, UC, KSJ, ZIA, ABW, SZG, GP; data curation: RC, UC, JES, SR, GP; writing—first draft: RC, GP; writing—critical revision: RC, UC, LM, KSJ, ZIA, JES, SR, ABW, SZG, GP.

Corresponding author

Correspondence to Gregory Piazza.

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Conflict of interest

RC, ABW, SR have no relevant competing interests to declare. KJ is supported by the National Institutes of Health (Training Grant 5-T32 HL007604). GP receives research grant support from BMS/Pfizer Alliance, Amgen, BSC, Janssen, Bayer, and Alexion. SZG receives research grant support from Bayer Healthcare, Boehringer Ingelheim, BMS, Boston Scientific BTG EKOS, Daiichi, Jansen, NHLBI, and Pfizer, and consultant grant from Agile, Bayer Health-care, Boehringer Ingelheim, and Pfizer.

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Chopard, R., Campia, U., Morin, L. et al. Trends in management and outcomes of pulmonary embolism with a multidisciplinary response team. J Thromb Thrombolysis 54, 449–460 (2022). https://doi.org/10.1007/s11239-022-02697-3

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