Abstract 18008: Trends and Outcomes of Outpatient Management of Pulmonary Embolism in a Real World Setting
Introduction: Outpatient management of low-risk pulmonary embolism (PE) is recommended in guidelines. However, no studies have reported on population-based outcomes of outpatient management of PE.
Hypothesis: We hypothesized that the use of outpatient management of PE increased without a parallel increase in mortality.
Methods: Using the linked healthcare administrative databases of the province of Québec, Canada, we identified all patients with PE diagnosed in emergency room (ER) from 2000 to 2009. We classified patients as outpatients or inpatients and included them in separate cohorts of incident and recurrent PE. Primary outcomes were all-cause and PE-specific mortality at 90 days. We used Poisson regression to estimate incidence rate ratios (IRRs) comparing rates of the primary outcomes in 2005-2009 with 2000-2004 as reference, and adjusting for age, gender, provoked PE, concomitant deep vein thrombosis, Charlson comorbidity index, prior admissions, and length of ER stay.
Results: The incident PE cohort included 5044 patients (27% outpatients), and the recurrent PE cohort included 2398 (35.3% outpatients). The proportion of outpatients among the incident PE was higher in 2005-2009 compared with 2000-2004 (Odds ratio [OR], 1.19; 95% CI: 1.05-1.35), but was unchanged among recurrent PE (OR, 0.97; 95% CI: 0.82-1.15). Mortality rates were 3.2% and 8.1% for outpatients and inpatients with incident PE, respectively. Mortality in incident PE did not change during these periods for both outpatients (IRR, 0.86; 95% CI: 0.47-1.58) and inpatients (IRR, 1.15; 95% CI: 0.92-1.45). Mortality in recurrent PE also did not change for outpatients (IRR, 0.76, 95% CI: 0.34-1.66), but decreased for inpatients (IRR, 0.68; 95% CI: 0.50-0.93). Death rates due to PE were stable with incident PE, but decreased for inpatients with recurrent PE (IRR, 0.51; 95% CI: 0.32-0.81).
Conclusions: Outpatient management of acute PE is common and its use has increased in incident PE while mortality has remained stable or even decreased in some patient groups.
Author Disclosures: A.J. Klil-Drori: None. J. Coulombe: None. S. Suissa: Consultant/Advisory Board; Modest; Bayer, Boehringer Ingelheim, Bristol-Myers Squibb. A. Hirsch: None. V. Tagalakis: None.
- © 2016 by American Heart Association, Inc.