Background
Methods
Study Design
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PERT Presence: To evaluate the impact of establishing a PERT, we compared clinical outcomes in the two years preceding and following PERT implementation: from April 2017 to March 2019, as compared to April 2019 to April 2021.
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PERT Consultation: To evaluate the impact of PERT consultation, we compared clinical outcomes in patients who received PERT consultation (PC) and those who did not (NPC) in the two years following PERT implementation (post-implementation era): from April 2019 to April 2021.
Statistical analysis
Results
PERT Presence
PERT PRESENT | PERT CONSULTED | |||||
---|---|---|---|---|---|---|
Pre-PERT: n = 319 patients1 | Post-PERT: n = 367 patients1 | p-value2 | PERT NOT CONSULTED: n = 166 patients1 | PERT CONSULTED: n = 201 patients1 | p-value2 | |
Patient demographics | ||||||
Age (Years) | 62 (52, 73) | 64 (53, 73) | 0.6 | 65 (53, 74) | 63 (53, 72) | 0.4 |
Sex | 0.4 | 0.7 | ||||
Male | 175 (54.9%) | 212 (58%) | 98 (59.0%) | 114 (56.7%) | ||
Female | 144 (45.1%) | 155 (42%) | 68 (41.0%) | 87 (43.3%) | ||
Clinical covariates | ||||||
COPD | 37 (11.6%) | 41 (11.2%) | > 0.9 | 11 (6.6%) | 30 (14.9%) | 0.012* |
Congestive heart failure | 51 (16.0%) | 56 (15.3%) | 0.8 | 33 (19.9%) | 23 (11.4%) | 0.025* |
ILD | 8 (2.5%) | 11 (3.0%) | 0.7 | 8 (4.8%) | 3 (1.5%) | 0.072 |
Pulmonary HTN | 28 (8.8%) | 30 (8.2%) | 0.8 | 11 (6.6%) | 19 (9.5%) | 0.3 |
Active Cancer | 104 (32.6%) | 83 (22.6%) | 0.003* | 48 (28.9%) | 35 (17.4%) | 0.009* |
History of Venous Thromboembolism | 66 (20.7%) | 56 (15.3%) | 0.064 | 19 (11.4%) | 37 (18.4%) | 0.065 |
Cirrhosis | 4 (1.3%) | 7 (1.9%) | 0.5 | 6 (3.6%) | 1 (0.5%) | 0.049* |
History of GI Bleed | 12 (3.8%) | 15 (4.1%) | 0.8 | 7 (4.2%) | 8 (4.0%) | > 0.9 |
History of Thrombophilia | 8 (2.5%) | 9 (2.5%) | > 0.9 | 1 (0.6%) | 8 (4.0%) | 0.044* |
Autoimmune Disease | 47 (14.7%) | 48 (13.1%) | 0.5 | 25 (15.1%) | 23 (11.4%) | 0.3 |
History of COVID-19 | 0 (0%) | 44 (12%) | < 0.001* | 24 (14%) | 20 (10.0%) | 0.3 |
Home anticoagulation | 25 (7.8%) | 14 (3.8%) | 0.023* | 8 (4.8%) | 6 (3.0%) | 0.4 |
Apixaban | 6 (24.0%) | 3 (21.4%) | 2 (25.0%) | 1 (16.7%) | ||
Dabigatran | 1 (4.0%) | 0 (0.0%) | 0 (0.0%) | 0 (0.0%) | ||
Dalteparin | 2 (8.0%) | 1 (0.0%) | 1 (0.0%) | 0 (0.0%) | ||
Edoxaban | 0 (0.0%) | 2 (7.1%) | 2 (12.5%) 0 | 1 (0.0%) | ||
Enoxaparin | 4 (16.0%) | 1 (7.1%) | (0.0%) | 2 (16.7%) | ||
Rivaroxaban | 5 (20.0%) | 3 (21.4%) | 1 (12.5%) | 3 (33.3%) | ||
Warfarin | 7 (28.0%) | 6 (42.9%) | 4 (50.0%) | 2 (33.3%) | ||
Active Bleed at Diagnosis | 19 (6.0%) | 21 (5.7%) | 0.9 | 15 (9.0%) | 6 (3.0%) | 0.013* |
Presence of PE contributed to admission | 226 (70.8*%) | 270 (73.6%) | 0.5 | 96 (57%) | 175 (87%) | < 0.001 |
Clinical findings | ||||||
Troponin-I | 0.10 (0.02, 0.44) | 0.08 (0.02, 0.3) | 0.3 | 0.07 (0.02, 0.22) | 0.10 (0.03, 0.36) | 0.11 |
BNP | 228 (82, 592) | 201 (71, 559) | 0.3 | 200 (74, 462) | 201 (70, 563) | 0.9 |
Echocardiographic Evidence of RH Strain | 0.2 | < 0.001* | ||||
Yes | 227 (71.2%) | 263 (71.7%) | 97 (58.4%) | 166 (82.6%) | ||
No | 54 (16.9%) | 74 (20.2%) | 40 (24.1%) | 34 (16.9%) | ||
Not Obtained | 38 (11.9%) | 30 (8.2%) | 29 (17.5%) | 1 (0.5%) | ||
CT Evidence of RH Strain | 0.4 | < 0.001* | ||||
Yes | 193 (60.5%) | 221 (60.2%) | 76 (46%) | 145 (72.1%) | ||
No | 111 (34.8%) | 136 (37.1%) | 85 (51%) | 51 (25.4%) | ||
Not Obtained | 15 (4.7%) | 10 (2.7) | 5 (3.0%) | 5 (2.5%) | ||
Full Risk Stratification Obtained (troponin or BNP, plus CT or TTE) | 196 (61.4%) | 277 (75.5%) | < 0.001* | 89 (53.6%) | 188 (93.5%) | < 0.001* |
PE Classification | 0.2 | 0.004* | ||||
High-Risk | 36 (13.2%) | 31 (9.1%) | 12 (8.5%) | 19 (9.6%) | ||
Intermediate-High Risk | 151 (55.3%) | 188 (55%) | 65 (46%) | 123 (62%) | ||
Intermediate-Low Risk | 86 (31.5%) | 121 (36%) | 65 (46%) | 56 (28%) | ||
Not Risk Stratified | 46 (14.4%) | 27 (7.4%) | 24 (14.5%) | 3 (1.5%) | ||
PESI | 106 (83,134) | 105 (82, 138) | 0.7 | 110 (85, 138) | 104 (80, 138) | 0.6 |
PERT PRESENT | PERT CONSULTED | |||||
---|---|---|---|---|---|---|
Interventions and Patient Outcomes | Pre-PERT: n = 317 patients1 | Post-PERT: n = 369 patients1 | p-value2 | PERT NOT CONSULTED: n = 168 patients1 | PERT CONSULTED: n = 201 patients1 | p-value2 |
Systemic Anticoagulant | 308 (96.6%) | 355 (96.7%) | 0.9 | 156 (94.0%) | 199 (99.0%) | 0.007* |
Systemic Anticoagulation Medication | 1.0 | 0.02* | ||||
Apixaban | 4 (1.3%) | 7 (2.0%) | 3 (1.9%) | 4 (2.0%) 0 | ||
Argatraban | 0 (0%) | 1 (0.3%) | 1 (0.6%) | (0%) | ||
Dalteparin | 16 (5.2%) | 3 (0.8%) | 1 (0.6%) | 2 (1.0%) | ||
Edoxaban | 1 (0.3%) | 0 (0%) | 0 (0%) | 0 (0%) | ||
Enoxaparin | 54 (18%) | 106 (30%) | 38 (24%) | 68 (34%) | ||
Other | 0 (0%) | 1 (0.3%) | 0 (0%) | 1 (0.5%) | ||
Rivaroxaban | 11 (3.6%) | 10 (2.8%) | 4 (2.5%) | 6 (3.0%) | ||
Unfiltered Heparin | 217 (71%) | 228 (64%) | 110 (70%) | 118 (59%) | ||
Warfarin | 2 (0.7%) | 1 (0.3%) | 1 (0.6%) | 0 (0%) | ||
Time to Therapeutic AC (Hours) | 8 (6, 20) | 8 (6, 22) | 0.6 | 8 (6, 23) | 8 (6, 15) | 0.3 |
Number of Procedures | 66 (20.8%) | 42 (11.4%) | 0.01* | 16 (9.5%) | 26 (12.9%) | 0.4 |
Procedural Intervention | ||||||
Catheter-Directed Lysis | 15 (4.7%) | 2 (0.5%) | < 0.001* | 1 (0.6%) | 1 (0.5%) | > 0.9 |
IVC Filter | 42 (13.2) | 24 (6.5%) 1 | 0.003* | 13 (7.8%) | 11 (5.5%) 1 | 0.4 |
Surgical Intervention | 4 (1.3%) | (0.3%) | 0.2 | 0 (0.0%) | (0.5%) | > 0.9 |
Thromboaspiration | 5 (1.6%) | 15 (4.1%) | 0.050 | 2 (1.2%) | 13 (6.5%) | 0.015* |
Systemic Thrombolysis | 20 (6.3%) | 19 (5.2%) | 0.5 | 4 (2.4%) | 15 (7.5%) | 0.030* |
Hospital Length of Stay (days) | 6 (2, 11) | 6 (3, 12) | 0.12 | 9 (4, 18) | 4 (2, 8) | < 0.001* |
ICU Length of Stay (days) | 0 (0, 4) | 0 (0, 4) | 0.6 | 2 (0, 7) | 0 (0, 2) | < 0.001* |
30-Day Mortality | 0.78 | 0.0024* | ||||
Alive at 30 Days | 276 (87.0%) | 321 (87.0%) | 132 (80%) | 189 (94%) | ||
Dead at 30 Days | 37 (12.0%) | 43 (12.0%) | 33 (20%) | 10 (5.0%) | ||
Unknown | 3 (1.9%) | 3 (0.8%) | 1 (0.6%) | 2 (1.0%) | ||
Goals of Care Precluded PERT Consult | – – | – | 12 (7.1%) N/A – |
PERT PRESENT | PERT CONSULTED | |
---|---|---|
30 Day mortality | ||
Odds ratio | 1.06 | 0.34 |
95% Confidence Interval | 0.70, 0.162 | 0.18, 0.61 |
p-value | 0.8 | < 0.001* |
Hospital length-of-stay | ||
Beta | -0.19 | -5.4 |
95% CI | -2.5, 2.1 | -8.2, -2.5 |
p-value | 0.9 | < 0.001* |
Time to therapeutic anticoagulation | ||
Odds ratio | 0.15 | -0.25 |
95% CI | -0.03, 0.33 | -0.49, -0.01 |
p-value | 0.10 | 0.041* |
Active bleeding | ||
Odds ratio | 0.99 | 0.28 |
95% CI | 0.51, 1.90 | 0.09, 0.76 |
p-value | > 0.9 | 0.011* |