Abstract 13506: Reduced Mortality After Implementation of a Multidisciplinary Pulmonary Embolism Response Team

Autor:	Yu Lin Chen, Mark A. Marinescu, Scott J. Cameron, Bryan Barrus, Justin Mazillo, Annelise Hamer, Nicole M. Acquisto, Ayman Elbadawi, Igor Gosev, Anthony P. Pietropaoli, Joseph Van Galen, Colin Wright, Susan Schleede, Joseph M. Delehanty, Scott McNitt, Ilan Goldenberg
Rok vydání:	2020
Předmět:	medicine.medical_specialty Multidisciplinary approach business.industry Physiology (medical) Medicine Cardiology and Cardiovascular Medicine business medicine.disease Intensive care medicine Venous disease Vascular Medicine Pulmonary embolism
Zdroj:	Circulation. 142
ISSN:	1524-4539 0009-7322
Popis:	Introduction: Multidisciplinary Pulmonary Embolism Response Teams (PERTs) improve the care of patients with high risk pulmonary embolism (PE). The effect of a PERT on long-term mortality has never been evaluated. Hypothesis: We assessed the hypothesis that PERT would improve mortality of patients with high risk PE. Methods: An observational analysis was conducted of patients before PERT (pre-PERT, N = 137, between 2014 and 2015) after PERT (post-PERT, N = 231, from 2016 to 2019) presenting to the emergency department of a large academic medical center with submassive and massive PE. The primary outcome was six-month mortality with univariate and multivariate analyses. Results: PERT was associated with a sustained reduction in Kaplan-Meier mortality estimates (Figure) through six months (six-month mortality rates of 14% post-PERT vs. 24% pre-PERT, unadjusted HR of 0.57, RRR of 43%, NNT of 10, log-rank p=0.025). A Cox proportional hazards model demonstrated no difference in mortality from diagnosis through 1 month after presentation (HR 1.11 vs pre-PERT, 95% CI 0.55-2.26, p=0.766), but confirmed a reduction in mortality 1-6 months after diagnosis post-PERT (HR 0.42 vs pre-PERT, 95% CI 0.19-0.95, p=0.037). There was a reduced length of stay post-PERT (9.1± 10.8 vs 6.5 ± 9.8 days pre-PERT, P=0.007). Time from triage to diagnosis of PE was independently predictive of mortality, and the risk of mortality was reduced by 4.6% for each hour earlier that the diagnosis was made. Conclusions: In conclusion, this study is the first to demonstrate an association between PERT implementation and reduction in 6-month mortality in patients with high risk PE. This effect of reduced time to PE diagnosis associated with a multidisciplinary PERT may be a mechanism for the reduction in mortality.
Databáze:	OpenAIRE
Externí odkaz:	https://explore.openaire.eu/search/publication?articleId=doi_________::a915c2201cf43e223ce30a9e34657173 https://doi.org/10.1161/circ.142.suppl_3.13506 Zobrazit plný text záznamu