Management and Outcomes of Adults Diagnosed with Acute Pulmonary Embolism in Primary Care: Community-Based Retrospective Cohort Study

被引:11
|
作者
Vinson, David R. [1 ,2 ,3 ]
Hofmann, Erik R. [1 ,4 ]
Johnson, Elizabeth J. [5 ]
Rangarajan, Suresh [1 ,6 ]
Huang, Jie [2 ]
Isaacs, Dayna J. [7 ,8 ]
Shan, Judy [2 ,9 ]
Wallace, Karen L. [1 ,10 ]
Rauchwerger, Adina S. [2 ]
Reed, Mary E. [2 ]
Mark, Dustin G. [1 ,2 ,11 ,12 ]
机构
[1] Permanente Med Grp Inc, Oakland, CA USA
[2] Kaiser Permanente Div Res, Oakland, CA USA
[3] Kaiser Permanente Roseville Med Ctr, Dept Emergency Med, 1600 Eureka Rd, Roseville, CA 95661 USA
[4] Kaiser Permanente South Sacramento Med Ctr, Dept Emergency Med, Sacramento, CA USA
[5] UC Davis Hlth, Dept Emergency Med, Sacramento, CA USA
[6] Kaiser Permanente Oakland Med Ctr, Dept Adult & Family Med, Oakland, CA USA
[7] Univ Calif Davis, Sch Med, Sacramento, CA 95817 USA
[8] Univ Calif Los Angeles, Internal Med Residency Program, Los Angeles, CA USA
[9] Univ Calif San Francisco, Sch Med, San Francisco, CA USA
[10] Kaiser Permanente San Jose Med Ctr, Dept Radiol, San Jose, CA USA
[11] Kaiser Permanente Oakland Med Ctr, Dept Emergency, Oakland, CA USA
[12] Kaiser Permanente Oakland Med Ctr, Dept Crit Care Med, Oakland, CA USA
关键词
pulmonary embolism; venous thromboembolism; general practice; family medicine; ambulatory care; outpatients; EMERGENCY-DEPARTMENT PATIENTS; OUTPATIENT TREATMENT; SAFETY; GUIDELINE; THERAPY; HESTIA;
D O I
10.1007/s11606-021-07289-0
中图分类号
R19 [保健组织与事业(卫生事业管理)];
学科分类号
摘要
Background The management and outcomes of patients diagnosed with acute pulmonary embolism in primary care have not been characterized. Objective To describe 30-day outcomes stratified by initial site-of-care decisions Design Multicenter retrospective cohort study Participants Adults diagnosed with acute pulmonary embolism in primary care in a large, diverse community-based US health system (2013-2019) Main Measures The primary outcome was a composite of 30-day serious adverse events (recurrent venous thromboembolism, major bleeding, and all-cause mortality). The secondary outcome was 7-day pulmonary embolism-related hospitalization, either initial or delayed. Key Results Among 652 patient encounters (from 646 patients), median age was 64 years; 51.5% were male and 70.7% identified as non-Hispanic white. Overall, 134 cases (20.6%) were sent home from primary care and 518 cases (79.4%) were initially referred to the emergency department (ED) or hospital. Among the referred, 196 (37.8%) were discharged home from the ED without events. Eight patients (1.2%; 95% CI 0.5-2.4%) experienced a 30-day serious adverse event: 4 venous thromboemboli (0.6%), 1 major bleed (0.2%), and 3 deaths (0.5%). Seven of these patients were initially hospitalized, and 1 had been sent home from primary care. All 3 deaths occurred in patients with known metastatic cancer initially referred to the ED, hospitalized, then enrolled in hospice following discharge. Overall, 328 patients (50.3%) were hospitalized within 7 days: 322 at the time of the index diagnosis and 6 following initial outpatient management (4 clinic-only and 2 clinic-plus-ED patients). Conclusions Patients diagnosed with acute pulmonary embolism in this primary care setting uncommonly experienced 30-day adverse events, regardless of initial site-of-care decisions. Over 20% were managed comprehensively by primary care. Delayed 7-day pulmonary embolism-related hospitalization was rare among the 51% treated as outpatients. Primary care management of acute pulmonary embolism appears to be safe and could have implications for cost-effectiveness and patient care experience.
引用
收藏
页码:3620 / 3629
页数:10
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