Reasons for Hospitalization of Patients with Acute Pulmonary Embolism Based on the Hestia Decision Rule

Stephan V. Hendriks; Paul L. den Exter; Wendy Zondag; Rolf Brouwer; Michiel Eijsvogel; Marco J. Grootenboers; Laura M. Faber; Roxanne Heller-Baan; Herman M. A. Hofstee; Antonio Iglesias del Sol; Marieke J. H. A. Kruip; Albert T. A. Mairuhu; Christian F. Melissant; Henny G. Peltenburg; Marcel A. van de Ree; Erik H. Serné; Menno V. Huisman; Frederikus A. Klok; on behalf of the Hestia/Vesta investigators

doi:10.1055/s-0040-1713170

Thrombosis and Haemostasis, Inhaltsverzeichnis

Thromb Haemost 2020; 120(08): 1217-1220
DOI: 10.1055/s-0040-1713170

Stroke, Systemic or Venous Thromboembolism

Reasons for Hospitalization of Patients with Acute Pulmonary Embolism Based on the Hestia Decision Rule

Autoren

Stephan V. Hendriks

¹Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, The Netherlands

²Department of Internal Medicine, Haga Teaching Hospital, The Hague, The Netherlands
Paul L. den Exter

¹Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, The Netherlands
Wendy Zondag

¹Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, The Netherlands
Rolf Brouwer

³Department of Internal Medicine, Reinier de Graaff Gasthuis, Delft, The Netherlands
Michiel Eijsvogel

⁴Department of Pulmonary Medicine, Medisch Spectrum Twente, Enschede, The Netherlands
Marco J. Grootenboers

⁵Department of Pulmonary Medicine, Amphia Hospital, Breda, The Netherlands
Laura M. Faber

⁶Department of Pulmonary Medicine, Rode Kruis Hospital, Beverwijk, The Netherlands
Roxanne Heller-Baan

⁷Department of Pulmonary Medicine, Ikazia Hospital, Rotterdam, The Netherlands
Herman M. A. Hofstee

⁸Department of Internal Medicine, Haaglanden Medical Center, The Hague, The Netherlands
Antonio Iglesias del Sol

⁹Department of Internal Medicine, Alrijne Hospital, Leiderdorp, The Netherlands
Marieke J. H. A. Kruip

¹⁰Department of Haematology, Erasmus University Medical Center, Rotterdam, The Netherlands
Albert T. A. Mairuhu

²Department of Internal Medicine, Haga Teaching Hospital, The Hague, The Netherlands
Christian F. Melissant

¹¹Department of Pulmonary Medicine, Spaarne Hospital, Hoofddorp, The Netherlands
Henny G. Peltenburg

¹²Department of Internal Medicine, Groene Hart Hospital, Gouda, The Netherlands
Marcel A. van de Ree

¹³Department of Internal Medicine, Diakonessenhuis, Utrecht, The Netherlands
Erik H. Serné

¹⁴Department of Internal Medicine, VU Medical Center, Amsterdam, The Netherlands
Menno V. Huisman

¹Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, The Netherlands
Frederikus A. Klok

¹Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, The Netherlands

on behalf of the Hestia/Vesta investigators

Abstract

Background The Hestia criteria can be used to select pulmonary embolism (PE) patients for outpatient treatment. The subjective Hestia criterion “medical/social reason for admission” allows the treating physician to consider any patient-specific circumstances in the final management decision. It is unknown how often and why this criterion is scored.

Methods This is a patient-level post hoc analysis of the combined Hestia and Vesta studies. The main outcomes were the frequency of all scored Hestia items in hospitalized patients and the explicit reason for scoring the subjective criterion. Hemodynamic parameters and computed tomography-assessed right ventricular (RV)/left ventricular (LV) ratio of those only awarded with the subjective criterion were compared with patients treated at home.

Results From the 1,166 patients screened, data were available for all 600 who were hospitalized. Most were hospitalized to receive oxygen therapy (45%); 227 (38%) were only awarded with the subjective criterion, of whom 51 because of “intermediate to intermediate-high risk PE.” Compared with patients with intermediate risk PE (RV/LV ratio > 1.0) treated at home (179/566, 32%), hospitalized patients with only the subjective criterion had a higher mean RV/LV ratio (mean difference +0.30, 95% confidence interval [CI] 0.19–0.41) and a higher heart rate (+18/min, 95% CI 10–25). No relevant differences were observed for other hemodynamic parameters.

Conclusion The most frequent reason for hospital admission was oxygen therapy. In the decision to award the subjective criterion as sole argument for admission, the severity of the RV overload and resulting hemodynamic response of the patient was taken into account rather than just abnormal RV/LV ratio.

Keywords

pulmonary embolism - hospitalization - bleeding - mortality - oral anticoagulants

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References
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