Trends in home treatment and early discharge of patients with low-risk pulmonary embolism.

Abstract

Background: Recent guidelines recommend a strategy of home treatment or early discharge in low-risk pulmonary embolism (PE). Contemporary rates of the implementation of this approach in everyday clinical practice are unknown.

Methods: Based on the US Nationwide Emergency Department Sample (NEDS) and Nationwide Readmission Database (NRD), we identified low-risk PE patients (absence of haemodynamic instability, cor pulmonale, tachycardia, dyspnea, hypothermia, altered mental status, and fulfilment of the Hestia critieria). We analyzed the proportion of direct or early (<48 hours) discharge and the association with demographic and clinical variables. We also studied the ninety-day occurrence of venous thromboembolism (VTE) recurrence and major bleeding.

Results: From 2016 to 2020, 641,621 (30.6%) of 2,099,390 PE cases in the NEDS database were low-risk. Among low-risk PE, 31.5% received home treatment, compared to 15.4% for those not classified as low-risk. Home treatment for low-risk patients showed an increasing trend over time. In the NRD database, 481,321 (24.7%) of 1,950,708 PE hospitalizations were classified as low-risk. An early discharge strategy was followed in 22.6% of all cases, increasing to 45.9% for low-risk PE admissions, with a rising trend observed from 2016. Factors associated with home treatment or early discharge among low-risk included age, sex, and absence of comorbidities. Ninety-day incidence of VTE recurrence and major bleeding was low among low-risk patients with early discharge (1.3% and 1.5%, respectively).

Conclusion: There is an increasing adoption of home treatment and early discharge for low-risk PE in routine practice. This approach appears safe, supporting findings from previous trials.