Interhospital Transfer for the Management of Acute Pulmonary Embolism

Link to article at PubMed

Am J Med. 2021 Dec 24:S0002-9343(21)00815-9. doi: 10.1016/j.amjmed.2021.11.015. Online ahead of print.


BACKGROUND: There are growing treatment options for management of acute pulmonary embolism (PE), though many are only available at tertiary care centers. Patients with acute PE with high-risk features are often transferred for consideration of such therapies. There are limited data describing outcomes in patients transferred with acute pulmonary embolism.

METHODS: We evaluated patients with acute pulmonary embolism at our tertiary care center from August 2012 through August 2018 and compared clinical characteristics, pulmonary embolism features, management and outcomes in those transferred for acute pulmonary embolism to those that were not transferred.

RESULTS: Of 2,050 pulmonary embolism patients included in the study, 432 (21.1%) were transferred from an outside hospital with a known diagnosis of pulmonary embolism. Patients transferred had a lower rate of malignancy (22.2% vs 33.3%; p<0.001) and median Charlson comorbidity index (3 vs 4; p<0.001). A higher percentage of patients transferred were classified as intermediate- or high-risk pulmonary embolism (62.5% vs 43.0%; <0.001) more frequently received advanced therapy beyond anticoagulation alone (12.5% vs 3.2%, p<0.001). Overall survival to discharge was similar between groups, though definite pulmonary embolism-related mortality was higher in the transferred group (38.5% vs 9.4%, p=0.004).

CONCLUSION: More than 1 in 5 patients treated for acute pulmonary embolism at a tertiary care center were transferred from an outside facility. Transferred patients had higher risk pulmonary embolism features, more often received advanced therapy, and had higher definite pulmonary embolism-related mortality. There are opportunities to further optimize outcomes of patients transferred for management of acute pulmonary embolism.

PMID:34954228 | DOI:10.1016/j.amjmed.2021.11.015

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