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

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.

Objective: To determine the proportion of patients with PE who fulfill eligibility criteria for home treatment or early discharge, to investigate in how many of them such a management strategy is actually followed, and to discover differences in early complications between early or later discharge among low-risk patients.

Methods: Based on the United States Nationwide Emergency Department Sample and Nationwide Readmission Database, we identified low-risk PE patients (absence of hemodynamic instability, cor pulmonale, tachycardia, dyspnea, hypothermia, altered mental status, and fulfillment of the Hestia criteria). We analyzed the proportion of direct or early (<48 hours) discharge and the association with demographic and clinical variables. We also studied the 90-day occurrence of venous thromboembolism recurrence and major bleeding.

Results: From 2016 to 2020, 641 621 (30.6%) of 2 099 390 PE cases in the Nationwide Emergency Department Sample database were low risk. Among low-risk PE, 31.5% received home treatment compared with 15.4% of those not classified as low risk. Home treatment for low-risk patients showed an increasing trend over time. In the Nationwide Readmission 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 patients included age, sex, and absence of comorbidities. Ninety-day incidence of venous thromboembolism 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.