A1 Journal article (refereed)
Survival and Quality of Life after Early Discharge in Low-Risk Pulmonary Embolism (2021)
Barco, S., Schmidtmann, I., Ageno, W., Anusić, T., Bauersachs, R.M., Becattini, C., Bernardi, E., Beyer-Westendorf, J., Bonacchini, L., Brachmann, J., Christ, M., Czihal, M., Duerschmied, D., Empen, K., Espinola-Klein, C., Ficker, J.H., Fonseca, C., Genth-Zotz, S., Jiménez, D., . . . Konstantinides, S.V. (2021). Survival and Quality of Life after Early Discharge in Low-Risk Pulmonary Embolism. European Respiratory Journal, 57(2), Article 2002368. https://doi.org/10.1183/13993003.02368-2020
JYU authors or editors
Publication details
All authors or editors: Barco, S.; Schmidtmann, I.; Ageno, W.; Anusić, T.; Bauersachs, R.M.; Becattini, C.; Bernardi, E.; Beyer-Westendorf, J.; Bonacchini, L.; Brachmann, J.; et al.
Journal or series: European Respiratory Journal
ISSN: 0903-1936
eISSN: 1399-3003
Publication year: 2021
Volume: 57
Issue number: 2
Article number: 2002368
Publisher: European Respiratory Society
Publication country: United Kingdom
Publication language: English
DOI: https://doi.org/10.1183/13993003.02368-2020
Publication open access: Not open
Publication channel open access:
Publication is parallel published: https://www.zora.uzh.ch/id/eprint/190000/1/ERJ-02368-2020.R1_Proof_hi.pdf
Additional information: On behalf of the HoT-PE Investigators.
Abstract
Methods: The multinational Home Treatment of Pulmonary Embolism (HoT-PE) single-arm management trial investigated early discharge followed by ambulatory treatment with rivaroxaban. The study was stopped for efficacy after the positive results of the predefined interim analysis at 50% of the planned population. The present analysis includes the entire trial population (576 patients). In addition to three-month recurrence (primary outcome) and one-year overall mortality, we analysed self-reported disease-specific (Pulmonary Embolism Quality of Life [PEmb-QoL] questionnaire) and generic (five-level five-dimension EuroQoL [EQ-5D-5L] scale) quality of life as well as treatment satisfaction (Anti-Clot Treatment Scale [ACTS]) after PE.
Results: The primary efficacy outcome occurred in three (0.5%; upper 95.0% CI 1.3%) patients. One-year mortality was 2.4%. The mean PEmb-QoL decreased from 28.9±20.6% at 3 weeks to 19.9±15.4% at 3 months, a mean change (improvement) of -9.1% (p<0.0001). Improvement was consistent across all PEmb-QoL dimensions. EQ-5D-5L was 0.89±0.12 3 weeks after enrolment and improved to 0.91±0.12 at 3 months (p<0.0001). Female sex and cardiopulmonary disease were associated with poorer disease-specific and generic quality of life; older age, with faster worsening of generic quality of life. The ACTS burden score improved from 40.5±6.6 points at 3 weeks to 42.5±5.9 at 3 months (p<0.0001).
Conclusions: Our results further support early discharge and ambulatory oral anticoagulation for selected patients with low-risk PE. Targeted strategies may be necessary to further improve quality of life in specific patient subgroups.
Keywords: cardiovascular diseases; embolus; patient discharge; home care; tracking; survival; quality of life
Contributing organizations
Ministry reporting: Yes
Reporting Year: 2021
JUFO rating: 3
