External validation of a claims-based and clinical approach for predicting post-pulmonary embolism outcomes among United States veterans
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The In-hospital Mortality for PulmonAry embolism using Claims daTa (IMPACT) rule can accurately identify pulmonary embolism (PE) patients at low risk of early complications using claims data. We sought to externally validate the IMPACT and simplified Pulmonary Embolism Severity Index (sPESI) tools for predicting all-cause mortality and readmission. We used Veteran Health Administration data (10/1/2010–9/30/2015) to identify adults with ≥1 inpatient diagnosis code for acute PE, ≥12 months continuous medical and pharmacy benefits prior to the index PE, ≥90 days of post-event follow-up (unless death occurred) and ≥1 claim for an anticoagulant during the index PE stay. Prognostic accuracies of IMPACT and sPESI for 30- and 90-day all-cause mortality and 90-day readmission were estimated. Of 6,746 PE patients, 7.5 and 12.6% died at 30 and 90 days. Within 90 days, 20.1% were readmitted for any reason. Hospitalization for recurrent VTE and major bleeding occurred in 5.6 and 1.7% of patients. IMPACT classified 15.2% as low risk, while 28.4% were low risk per sPESI. Both tools displayed sensitivity >90% and negative predictive values (NPVs) >97% for 30-day mortality, but low specificity (range 16.2–30.0) and positive predictive values (PPVs) (range 8.7–9.5); with similar results observed for 90-day mortality. IMPACT’s sensitivity for all-cause readmission was numerically higher than sPESI (88.2 vs. 79.0%), but both had comparable NPVs (85.1 vs. 84.2%). Similar trends were observed for VTE or major bleeding readmissions. IMPACT classified patients for post-PE outcomes with similar accuracy as sPESI. IMPACT appears useful for identifying PE patients at low risk for early mortality or readmission in claims-based studies.
KeywordsMortality Pulmonary embolism Prognosis Risk assessment Severity of illness index Administrative claim
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Conflict of interest
CIC has received grant funding and consultancy fees from Janssen Pharmaceuticals; Bayer Pharma AG and Boehringer-Ingelheim Pharmaceuticals, Inc. PW has received grant funding from Bristol Myers Squib and Pfizer, is on the advisory board and has received speaker’s fees from Bayer Healthcare, has received consultancy fees from Janssen Pharmaceuticals, and served on a writing committee with Itreas. CC and JRS are employees of Janssen Scientific Affairs LLC. WFP has received grant funding and consultancy fees from Janssen Pharmaceuticals and Portola. GJF has received grant funding from Pfizer and is on the advisory board and speaker’s bureau for Janssen Pharmaceuticals. LW and OB are employees of STATinMed, Plano, TX, USA. CGK, ERW and NK have no conflicts of interest germane to this manuscript to report. No non-financial conflicts of interest exist for any of the authors.
Statement of human and animal rights
This article does not contain any studies with human participants or animals performed by any of the authors.
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