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Lüthi-Corridori G, Giezendanner S, Kueng C, Boesing M, Leuppi-Taegtmeyer AB, Mbata MK, Schuetz P, Leuppi JD. Risk factors for hospital outcomes in pulmonary embolism: A retrospective cohort study. Front Med (Lausanne) 2023; 10:1120977. [PMID: 37113610 PMCID: PMC10126285 DOI: 10.3389/fmed.2023.1120977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Accepted: 03/15/2023] [Indexed: 04/29/2023] Open
Abstract
Background Pulmonary embolism (PE) is not only a life-threatening disease but also a public health issue with significant economic burden. The aim of the study was to identify factors-including the role of primary care-that predict length of hospital stay (LOHS), mortality and re-hospitalization within 6 months of patients admitted for PE. Method A retrospective cohort study was conducted with patients presenting to a Swiss public hospital with PE diagnosed at the hospital between November 2018 and October 2020. Multivariable logistic and zero-truncated negative binomial regression analyses were performed to assess risk factors for mortality, re-hospitalization and LOHS. Primary care variables encompassed whether patients were sent by their general practitioner (GP) to the emergency department and whether a GP follow-up assessment after discharge was recommended. Further analyzed variables were pulmonary embolism severity index (PESI) score, laboratory values, comorbidities, and medical history. Results A total of 248 patients were analyzed (median 73 years and 51.6% females). On average patients were hospitalized for 5 days (IQR 3-8). Altogether, 5.6% of these patients died in hospital, and 1.6% died within 30 days (all-cause mortality), 21.8% were re-hospitalized within 6 months. In addition to high PESI scores, we detected that, patients with an elevated serum troponin, as well as with diabetes had a significantly longer hospital stay. Significant risk factors for mortality were elevated NT-proBNP and PESI scores. Further, high PESI score and LOHS were associated with re-hospitalization within 6 months. PE patients who were sent to the emergency department by their GPs did not show improved outcomes. Follow-up with GPs did not have a significant effect on re-hospitalization. Conclusion Defining the factors that are associated with LOHS in patients with PE has clinical implications and may help clinicians to allocate adequate resources in the management of these patients. Serum troponin and diabetes in addition to PESI score might be of prognostic use for LOHS. In this single-center cohort study, PESI score was not only a valid predictive tool for mortality but also for long-term outcomes such as re-hospitalization within 6 months.
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Affiliation(s)
- Giorgia Lüthi-Corridori
- Cantonal Hospital Baselland, University Center of Internal Medicine, Liestal, Switzerland
- Faculty of Medicine, University of Basel, Basel, Switzerland
- *Correspondence: Giorgia Lüthi-Corridori,
| | - Stéphanie Giezendanner
- Cantonal Hospital Baselland, University Center of Internal Medicine, Liestal, Switzerland
- Faculty of Medicine, University of Basel, Basel, Switzerland
- Centre for Primary Health Care, University of Basel, Basel, Switzerland
| | - Cedrine Kueng
- Cantonal Hospital Baselland, University Center of Internal Medicine, Liestal, Switzerland
- Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Maria Boesing
- Cantonal Hospital Baselland, University Center of Internal Medicine, Liestal, Switzerland
- Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Anne B. Leuppi-Taegtmeyer
- Cantonal Hospital Baselland, University Center of Internal Medicine, Liestal, Switzerland
- Faculty of Medicine, University of Basel, Basel, Switzerland
- Department of Patient Safety, Medical Directorate, University Hospital Basel, Basel, Switzerland
| | | | - Philipp Schuetz
- Faculty of Medicine, University of Basel, Basel, Switzerland
- Cantonal Hospital Aarau, University Department of Medicine, Aarau, Switzerland
| | - Joerg D. Leuppi
- Cantonal Hospital Baselland, University Center of Internal Medicine, Liestal, Switzerland
- Faculty of Medicine, University of Basel, Basel, Switzerland
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Rodríguez-Núñez N, Ruano-Raviña A, Lama A, Ferreiro L, Ricoy J, Álvarez-Dobaño JM, Suárez-Antelo J, Toubes ME, Rábade C, Golpe A, Riveiro V, Casal A, Abelleira R, González-Barcala FJ, González-Juanatey JR, Valdés L. Evaluation of the impact of an integrated care pathway for pulmonary embolism: a quasi-experimental pre-post study. J Thorac Dis 2021; 13:5373-5382. [PMID: 34659804 PMCID: PMC8482338 DOI: 10.21037/jtd-21-595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 07/16/2021] [Indexed: 11/06/2022]
Abstract
Background An integrated care pathway (ICP) is intended to improve the management of prevalent resource-consuming, life-threatening diseases. The purpose of this study was to determine whether the quality of patient care improved with the establishment of a dedicated unit for pulmonary embolism (PE). Methods A quasi-experimental pre-post study (pre: years 2010–2013; post: 2015–2020; year 2014, “washing” period) of PE patients ≥18 years (January 2010–June 2020). The intervention involved the implementation of an ICP for PE. Results The sample was composed of 1,142 patients (510 pre-intervention and 612 post-intervention) without significant differences between the two populations. In the post-intervention period, significant reductions were observed in the median length of hospital stay (LOS) (8 vs. 6 days); time to start of oral anticoagulation therapy (4.5 vs. 3.5 days; P<0.001); and the percentage of patients with high-risk PE in whom recanalization was not contraindicated (66.7% vs. 96%; P=0.009). In-hospital and 30-day mortality decreased, although not significantly (4.5% vs. 2.8%; P=0.188; 6.1% vs. 5.2%; P=0.531, respectively). Multivariate logistic regression analysis showed that the median LOS intervention decreased significantly according to the service where patients were referred to, and with the use of the simplified PESI. During follow-up, lifelong anticoagulation was prescribed to a higher proportion of patients in the post-intervention period (30.7% vs. 69.3%; P<0.001). Conclusions Although an ICP for PE does not reduce mortality significantly, it improves the quality of patient care.
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Affiliation(s)
- Nuria Rodríguez-Núñez
- Department of Pulmonology, Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, Spain
| | - Alberto Ruano-Raviña
- Department of Preventive Medicine and Public Health, Universidad de Santiago de Compostela, Santiago de Compostela, Spain.,CIBER of Epidemiology and Public Health, CIBERESP, Madrid, Spain.,Group C013, Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | - Adriana Lama
- Department of Pulmonology, Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, Spain
| | - Lucía Ferreiro
- Department of Pulmonology, Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, Spain.,Interdisciplinary Research Group on Pulmonology, Instituto de Investigaciones Sanitarias de Santiago (IDIS), Santiago de Compostela, Spain
| | - Jorge Ricoy
- Department of Pulmonology, Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, Spain
| | - José M Álvarez-Dobaño
- Department of Pulmonology, Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, Spain.,Interdisciplinary Research Group on Pulmonology, Instituto de Investigaciones Sanitarias de Santiago (IDIS), Santiago de Compostela, Spain
| | - Juan Suárez-Antelo
- Department of Pulmonology, Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, Spain
| | - M Elena Toubes
- Department of Pulmonology, Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, Spain
| | - Carlos Rábade
- Department of Pulmonology, Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, Spain
| | - Antonio Golpe
- Department of Pulmonology, Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, Spain.,Interdisciplinary Research Group on Pulmonology, Instituto de Investigaciones Sanitarias de Santiago (IDIS), Santiago de Compostela, Spain
| | - Vanessa Riveiro
- Department of Pulmonology, Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, Spain
| | - Ana Casal
- Department of Pulmonology, Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, Spain
| | - Romina Abelleira
- Department of Pulmonology, Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, Spain
| | - Francisco Javier González-Barcala
- Department of Pulmonology, Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, Spain.,Interdisciplinary Research Group on Pulmonology, Instituto de Investigaciones Sanitarias de Santiago (IDIS), Santiago de Compostela, Spain
| | - José R González-Juanatey
- Service of Cardiology, Spanish Network-Center for Cardiovascular Biomedical Research (CIBERCV), Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | - Luis Valdés
- Department of Pulmonology, Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, Spain.,Interdisciplinary Research Group on Pulmonology, Instituto de Investigaciones Sanitarias de Santiago (IDIS), Santiago de Compostela, Spain
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Rodríguez-Núñez N, Ruano-Raviña A, Lama A, Ferreiro L, Ricoy J, Álvarez-Dobaño JM, Suárez-Antelo J, Toubes ME, Rábade C, Golpe A, Lourido T, González-Barcala FJ, Valdés L. Impact of cardiovascular risk factors on the clinical presentation and survival of pulmonary embolism without identifiable risk factor. J Thorac Dis 2020; 12:5411-5419. [PMID: 33209374 PMCID: PMC7656446 DOI: 10.21037/jtd-20-1634] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Accepted: 08/28/2020] [Indexed: 01/04/2023]
Abstract
BACKGROUND The nature of pulmonary embolism (PE) without identifiable risk factor (IRF) remains unclear. The objective of this study is to investigate the potential relationship between cardiovascular risk factors (CVRFs) and PE without IRF (unprovoked) and assess their role as markers of disease severity and prognosis. METHODS A case-control study was performed of patients with PE admitted to our hospital [2010-2019]. Subjects with PE without IRF were included in the cohort of cases, whereas patients with PE with IRF were allocated to the control group. Variables of interest included age, active smoking, obesity, and diagnosis of arterial hypertension, dyslipidemia or diabetes mellitus. RESULTS A total of 1,166 patients were included in the study, of whom 64.2% had PE without IRF. The risk for PE without IRF increased with age [odds ratio (OR): 2.68; 95% confidence interval (CI): 1.95-3.68], arterial hypertension (OR: 1.63; 95% CI: 1.27-2.07), and dyslipidemia (OR: 1.63; 95% CI: 1.24-2.15). The risk for PE without IRF was higher as the number of CVRF increased, being 3.99 (95% CI: 2.02-7.90) for subjects with ≥3 CVRF. The percentage of high-risk unprovoked PE increased significantly as the number of CVRF rose [0.6% for no CVRF; 23.8% for a CRF, P<0.001 (OR: 9.92; 95% CI: 2.82-34.9); 37.5% for two CRFs, P<0.001 (OR: 14.8; 95% CI: 4.25-51.85); and 38.1% for ≥3, P<0.001 (OR: 14.1; 95% CI: 4.06-49.4)]. No significant differences were observed in 1-month survival between cases and controls, whereas differences in 24-month survival reached significance. CONCLUSIONS A relationship was observed between CVRF and PE without IRF, as the risk for unprovoked PE increased with the number of CVRF. In addition, the number of CVRF was associated with PE without IRF severity, but not with prognosis.
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Affiliation(s)
- Nuria Rodríguez-Núñez
- Department of Pulmonology, Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, Spain
| | - Alberto Ruano-Raviña
- Department of Preventive Medicine and Public Health, Universidad de Santiago de Compostela, Santiago de Compostela, Spain
- CIBER of Epidemiology and Public Health, CIBERESP, Madrid, Spain
| | - Adriana Lama
- Department of Pulmonology, Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, Spain
| | - Lucía Ferreiro
- Department of Pulmonology, Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, Spain
- Interdisciplinary Research Group on Pulmonology, Instituto de Investigaciones Sanitarias de Santiago (IDIS), Santiago de Compostela, Spain
| | - Jorge Ricoy
- Department of Pulmonology, Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, Spain
| | - José M. Álvarez-Dobaño
- Department of Pulmonology, Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, Spain
- Interdisciplinary Research Group on Pulmonology, Instituto de Investigaciones Sanitarias de Santiago (IDIS), Santiago de Compostela, Spain
| | - Juan Suárez-Antelo
- Department of Pulmonology, Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, Spain
| | - M. Elena Toubes
- Department of Pulmonology, Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, Spain
| | - Carlos Rábade
- Department of Pulmonology, Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, Spain
| | - Antonio Golpe
- Department of Pulmonology, Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, Spain
- Interdisciplinary Research Group on Pulmonology, Instituto de Investigaciones Sanitarias de Santiago (IDIS), Santiago de Compostela, Spain
| | - Tamara Lourido
- Department of Pulmonology, Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, Spain
| | - Francisco Javier González-Barcala
- Department of Pulmonology, Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, Spain
- Interdisciplinary Research Group on Pulmonology, Instituto de Investigaciones Sanitarias de Santiago (IDIS), Santiago de Compostela, Spain
| | - Luis Valdés
- Department of Pulmonology, Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, Spain
- Interdisciplinary Research Group on Pulmonology, Instituto de Investigaciones Sanitarias de Santiago (IDIS), Santiago de Compostela, Spain
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