Publicaciones científicas

Survival and Quality of Life after Early Discharge in Low-Risk Pulmonary Embolism

28-ago-2020 | Revista: The European Respiratory Journal

Stefano Barco  1   2 , Irene Schmidtmann  3 , Walter Ageno  4 , Toni Anušić  3 , Rupert M Bauersachs  5 , Cecilia Becattini  6 , Enrico Bernardi  7 , Jan Beyer-Westendorf  8   9 , Luca Bonacchini  10 , Johannes Brachmann  11 , Michael Christ  12 , Michael Czihal  13 , Daniel Duerschmied  14 , Klaus Empen  15 , Christine Espinola-Klein  16 , Joachim H Ficker  17 , Cândida Fonseca  18 , Sabine Genth-Zotz  19 , David Jiménez  20 , Veli-Pekka Harjola  21 , Matthias Held  22 , Lorenzo Iogna Prat  23 , Tobias J Lange  24 , Mareike Lankeit  1   25   26 , Athanasios Manolis  27 , Andreas Meyer  28 , Thomas Münzel  16   29 , Pirjo Mustonen  30 , Ursula Rauch-Kroehnert  31   32 , Pedro Ruiz-Artacho  33   34   35   36 , Sebastian Schellong  37 , Martin Schwaiblmair  38 , Raoul Stahrenberg  39 , Luca Valerio  1 , Peter E Westerweel  40 , Philipp S Wild  1   29   41 , Stavros V Konstantinides  1   42 , HoT-PE Investigators


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.

CITA DEL ARTÍCULO  Eur Respir J . 2020 Aug 28;2002368. doi: 10.1183/13993003.02368-2020

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