Hestia criteria can discriminate high- from low-risk patients with pulmonary embolism

Abstract

We investigated whether the clinical criteria used in the Hestia study for selection of pulmonary embolism (PE) patients for outpatient treatment could discriminate PE patients with high and low risk for adverse clinical outcome.

We performed a cohort study with PE patients who were triaged with 11 criteria for outpatient treatment. Patients not eligible for outpatient treatment were treated in hospital. Study outcomes were recurrent venous thromboembolism, major bleeding and all-cause mortality during 3 months.

In total, 530 patients were included, of which 297 were treated at home. In the outpatient group, six patients (2.0%, 95% CI 0.7–4.3%) had recurrent venous thromboembolism versus nine in-patients (3.9%, 95% CI 1.9–7.0%). Three patients (1.0%, 95% CI 0.2–2.9) died during the 3-months follow-up in the outpatient group versus 22 patients (9.6%, 95% CI 6.3–14) in the in-patient group (p<0.05). None of the outpatients died as a result of fatal PE versus five (2.2%) in-patients (p<0.05). In the outpatient group, 0.7% (95% CI 0.08–2.4) had major bleeding events versus 4.8% (95% CI 2.4–8.4) of in-patients (p<0.05).

This study showed that the Hestia criteria can discriminate PE patients with low risk from patients with high risk for adverse clinical outcome. The low-risk patients can safely be treated at home.