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

Background: Early discharge of patients with acute low-risk pulmonary embolism (PE) requires validation by prospective trials with clinical and quality of life outcomes.

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

Preliminary JUFO rating: 3


Last updated on 2021-23-09 at 09:29