Gardner Tiffany A, Fuher Alexandra, Longino August, Sink Eric M, Jurica James, Park Bryan, Lindquist Jonathan, Bull Todd M, Hountras Peter
Pulmonary and Critical Care Fellowship Program, Massachusetts General Hospital & Beth Israel Deaconess Medical Center, Boston, MA, 02114, USA.
Internal Medicine Residency Program, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
Thromb J. 2024 Apr 19;22(1):38. doi: 10.1186/s12959-024-00605-8.
The management of acute pulmonary embolism (PE) has become increasingly complex with the expansion of advanced therapeutic options, resulting in the development and widespread adoption of multidisciplinary Pulmonary Embolism Response Teams (PERTs). Much of the literature evaluating the impact of PERTs has been limited by pre- postimplementation study design, leading to confounding by changes in global practice patterns over time, and has yielded mixed results. To address this ambiguity, we conducted a retrospective cohort study to evaluate the impact of the distinct exposures of PERT availability and direct PERT consultation.
At a single tertiary center, we conducted propensity-matched analyses of hospitalized patients with intermediate or high-risk PE. To assess the impact of PERT availability, we evaluated the changes in 30-day mortality, hospital length of stay (HLOS), time to therapeutic anticoagulation (TAC), in-hospital bleeding complications, and use of advanced therapies between the two years preceding and following PERT implementation. To evaluate the impact of direct PERT consultation, we conducted the same analyses in the post-PERT era, comparing patients who did and did not receive PERT consultation.
Six hundred eighty four patients were included, of which 315 were pre-PERT patients. Of the 367 postPERT patients, 201 received PERT consultation. For patients who received PERT consultation, we observed a significant reduction in 30-day mortality (5% vs 20%, OR 0.38, p = 0.0024), HLOS. (-5.4 days, p < 0.001), TAC (-0.25 h, p = 0.041), and in-hospital bleeding (OR 0.28, p = 0.011). These differences were not observed evaluating the impact of PERT presence in pre-vs postimplementation eras.
We observed a significant reduction in 30-day mortality, hospital LOS, TAC, and in-hospital bleeding complications for patients who received PERT consultation without an observed difference in these metrics when comparing the pre- vs post-implementation eras. This suggests the benefits stem from direct PERT involvement rather than the mere existence of PERT. Our data supports that PERT consultation may provide benefit to patients with acute intermediate or high-risk PE and can be achieved without a concomitant increase in advanced therapies.
随着先进治疗方案的不断扩展，急性肺栓塞（PE）的管理变得日益复杂，这促使多学科肺栓塞反应团队（PERTs）得以发展并广泛应用。许多评估PERTs影响的文献受到实施前后研究设计的限制，导致随着时间推移全球实践模式的变化产生混淆，且结果不一。为解决这一模糊性问题，我们进行了一项回顾性队列研究，以评估PERTs可用性和直接PERT会诊这两种不同暴露因素的影响。
在一个单一的三级中心，我们对中度或高危PE住院患者进行了倾向匹配分析。为评估PERTs可用性的影响，我们评估了PERT实施前后两年间30天死亡率、住院时间（HLOS）、开始治疗性抗凝的时间（TAC）、院内出血并发症以及先进治疗方法使用情况的变化。为评估直接PERT会诊的影响，我们在PERT时代之后进行了同样的分析，比较接受和未接受PERT会诊的患者。
共纳入684例患者，其中315例为PERT实施前的患者。在367例PERT实施后的患者中，201例接受了PERT会诊。对于接受PERT会诊的患者，我们观察到30天死亡率显著降低（5%对20%，OR 0.38，p = 0.0024），住院时间（-5.4天，p < 0.001），TAC（-0.25小时，p = 0.041），以及院内出血（OR 0.28，p = 0.011）。在评估PERT存在于实施前与实施后时代的影响时，未观察到这些差异。
我们观察到接受PERT会诊的患者30天死亡率、住院时间、TAC以及院内出血并发症显著降低，而在比较实施前与实施后时代时，这些指标没有观察到差异。这表明益处源于PERT的直接参与而非仅仅是PERT的存在。我们的数据支持PERT会诊可能为急性中度或高危PE患者带来益处，且无需同时增加先进治疗方法的使用。
