Management appropriateness and outcomes of patients with acute pulmonary embolism
Por:
Jimenez, D, Bikdeli, B, Barrios, D, Morillo, R, Nieto, R, Guerassimova, I, Muriel, A, Jara-Palomares, L, Moores, L, Tapson, V, Yusen, RD and Monreal, M
Publicada:
1 may 2018
Resumen:
The impact of adherence to published guidelines on the outcomes of patients with acute pulmonary embolism (PE) has not been well defined by previous studies.
In this prospective cohort study of patients admitted to a respiratory department (n=2096), we evaluated whether patients with PE had better outcomes if they were acutely managed according to international guidelines. Outcomes consisted of all-cause mortality, PE-related mortality, recurrent venous thromboembolism (VTE) and major bleeding events during the first month of follow-up after diagnosis.
Overall, 408 patients (19% (95% CI 18-21%)) did not receive guideline-adherent PE management. Patients receiving non-adherent management were significantly more likely to experience all-cause mortality (adjusted odds ratio (OR) 2.39 (95% CI 1.57-3.61) or PE-related mortality (adjusted OR 5.02 (95% CI 2.42-10.42); p< 0.001) during follow-up. Non-adherent management was also a significant independent predictor of recurrent VTE (OR 2.19 (95% CI 1.11-4.32); p=0.03) and major bleeding (OR 2.65 (95% CI 1.66-4.24); p< 0.001). An external validation cohort of 34 380 patients with PE from the RIETE registry confirmed these findings.
PE management that does not adhere to guidelines for indications related to anticoagulation, thrombolytics and inferior vena cava filters is associated with worse patient outcomes.
Filiaciones:
Jimenez, D:
Hosp Ramon & Cajal, Resp Dept, Colmenar Rd Km 9,100, Madrid 28034, Spain
Univ Alcala, Dept Med, IRYCIS, Madrid, Spain
Bikdeli, B:
Columbia Univ, New York Presbyterian Hosp, Med Ctr, Div Cardiol,Dept Med, New York, NY USA
Yale Univ, Sch Med, CORE, New Haven, CT USA
Barrios, D:
Hosp Ramon & Cajal, Resp Dept, Colmenar Rd Km 9,100, Madrid 28034, Spain
Univ Alcala, Dept Med, IRYCIS, Madrid, Spain
Morillo, R:
Hosp Ramon & Cajal, Resp Dept, Colmenar Rd Km 9,100, Madrid 28034, Spain
Univ Alcala, Dept Med, IRYCIS, Madrid, Spain
Nieto, R:
Hosp Ramon & Cajal, Resp Dept, Colmenar Rd Km 9,100, Madrid 28034, Spain
Univ Alcala, Dept Med, IRYCIS, Madrid, Spain
Guerassimova, I:
Hosp Ramon & Cajal, Resp Dept, Colmenar Rd Km 9,100, Madrid 28034, Spain
Univ Alcala, Dept Med, IRYCIS, Madrid, Spain
Muriel, A:
Hosp Ramon & Cajal, IRYCIS, CIBERESP, Dept Biostat, Madrid, Spain
Jara-Palomares, L:
Hosp Virgen del Rocio, Resp Dept, Seville, Spain
Moores, L:
Uniformed Serv Univ Hlth Sci, F Edward Hebert Sch Med, Bethesda, MD USA
Tapson, V:
Cedars Sinai Med Ctr, Dept Med, Los Angeles, CA 90048 USA
Yusen, RD:
Washington Univ, Sch Med, Div Pulm & Crit Care Med, St Louis, MO USA
Washington Univ, Sch Med, Div Gen Med Sci, St Louis, MO USA
:
Hosp Badalona Germans Trias & Pujol, Dept Internal Med, Barcelona, Spain
Univ Catolica Murcia, Dept Med, Murcia, Spain
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