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Hospital volume and outcomes for acute pulmonary embolism: multinational population based cohort study.

ABSTRACT: OBJECTIVES:To evaluate the association between experience in the management of acute pulmonary embolism, reflected by hospital case volume, and mortality. DESIGN:Multinational population based cohort study using data from the Registro Informatizado de la Enfermedad TromboEmbólica (RIETE) registry between 1 January 2001 and 31 August 2018. SETTING:353 hospitals in 16 countries. PARTICIPANTS:39?257 consecutive patients with confirmed diagnosis of acute symptomatic pulmonary embolism. MAIN OUTCOME MEASURE:Pulmonary embolism related mortality within 30 days after diagnosis of the condition. RESULTS:Patients with acute symptomatic pulmonary embolism admitted to high volume hospitals (>40 pulmonary embolisms per year) had a higher burden of comorbidities. A significant inverse association was seen between annual hospital volume and pulmonary embolism related mortality. Admission to hospitals in the highest quarter (that is, >40 pulmonary embolisms per year) was associated with a 44% reduction in the adjusted odds of pulmonary embolism related mortality at 30 days compared with admission to hospitals in the lowest quarter (<15 pulmonary embolisms per year; adjusted risk 1.3% v 2.3%; adjusted odds ratio 0.56 (95% confidence interval 0.33 to 0.95); P=0.03). Results were consistent in all sensitivity analyses. All cause mortality at 30 days was not significantly reduced between the two quarters (adjusted odds ratio 0.78 (0.50 to 1.22); P=0.28). Survivors showed little change in the odds of recurrent venous thromboembolism (odds ratio 0.76 (0.49 to 1.19)) or major bleeding (1.07 (0.77 to 1.47)) between the low and high volume hospitals. CONCLUSIONS:In patients with acute symptomatic pulmonary embolism, admission to high volume hospitals was associated with significant reductions in adjusted pulmonary embolism related mortality at 30 days. These findings could have implications for management strategies.

SUBMITTER: Jimenez D

PROVIDER: S-EPMC6661688 | biostudies-literature | 2019 Jul

REPOSITORIES: biostudies-literature

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Hospital volume and outcomes for acute pulmonary embolism: multinational population based cohort study.

Jiménez David D Bikdeli Behnood B Quezada Andrés A Muriel Alfonso A Lobo José Luis JL de Miguel-Diez Javier J Jara-Palomares Luis L Ruiz-Artacho Pedro P Yusen Roger D RD Monreal Manuel M

BMJ (Clinical research ed.) 20190729

<h4>Objectives</h4>To evaluate the association between experience in the management of acute pulmonary embolism, reflected by hospital case volume, and mortality.<h4>Design</h4>Multinational population based cohort study using data from the Registro Informatizado de la Enfermedad TromboEmbólica (RIETE) registry between 1 January 2001 and 31 August 2018.<h4>Setting</h4>353 hospitals in 16 countries.<h4>Participants</h4>39 257 consecutive patients with confirmed diagnosis of acute symptomatic pulm ...[more]

PMID: 31358508

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Project description:BackgroundThe management and outcomes of patients diagnosed with acute pulmonary embolism in primary care have not been characterized.ObjectiveTo describe 30-day outcomes stratified by initial site-of-care decisions DESIGN: Multicenter retrospective cohort study PARTICIPANTS: Adults diagnosed with acute pulmonary embolism in primary care in a large, diverse community-based US health system (2013-2019) MAIN MEASURES: The primary outcome was a composite of 30-day serious adverse events (recurrent venous thromboembolism, major bleeding, and all-cause mortality). The secondary outcome was 7-day pulmonary embolism-related hospitalization, either initial or delayed.Key resultsAmong 652 patient encounters (from 646 patients), median age was 64 years; 51.5% were male and 70.7% identified as non-Hispanic white. Overall, 134 cases (20.6%) were sent home from primary care and 518 cases (79.4%) were initially referred to the emergency department (ED) or hospital. Among the referred, 196 (37.8%) were discharged home from the ED without events. Eight patients (1.2%; 95% CI 0.5-2.4%) experienced a 30-day serious adverse event: 4 venous thromboemboli (0.6%), 1 major bleed (0.2%), and 3 deaths (0.5%). Seven of these patients were initially hospitalized, and 1 had been sent home from primary care. All 3 deaths occurred in patients with known metastatic cancer initially referred to the ED, hospitalized, then enrolled in hospice following discharge. Overall, 328 patients (50.3%) were hospitalized within 7 days: 322 at the time of the index diagnosis and 6 following initial outpatient management (4 clinic-only and 2 clinic-plus-ED patients).ConclusionsPatients diagnosed with acute pulmonary embolism in this primary care setting uncommonly experienced 30-day adverse events, regardless of initial site-of-care decisions. Over 20% were managed comprehensively by primary care. Delayed 7-day pulmonary embolism-related hospitalization was rare among the 51% treated as outpatients. Primary care management of acute pulmonary embolism appears to be safe and could have implications for cost-effectiveness and patient care experience.

Dataset Information

Hospital volume and outcomes for acute pulmonary embolism: multinational population based cohort study.

Publications

Hospital volume and outcomes for acute pulmonary embolism: multinational population based cohort study.

Similar Datasets

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