Follow-up of acute pulmonary embolism (PE): need for dedicated PE clinics and multidisciplinary team (MDT) meetings?

Abstract

Background: PE is a common cause of morbidity and mortality. The European Society of Cardiology (ESC) guidelines propose follow up for all PE patients 3-6 months after the acute event.

Aims: To assess follow-up arrangements based on clinical risk and identify need for standardised care pathways.

Methods: This was a retrospective observational study of adult patients discharged with a diagnosis of acute PE from 25/01/19 to 31/07/19 at a UK teaching hospital. Obstetric patients and patients who died within 3 months were excluded from analysis. Risk was stratified using ESC guidelines and follow-up approach reviewed.

Results: A total of 300 patients were included in analysis; 5 (2%) were high risk, 52 (17%) intermediate high risk, 154 (51%) intermediate low risk, 81 (27%) low risk and 8 (3%) not risk stratified. Overall, 194 patients (65%) were followed up. Median time to follow up was 69 days.

The rates of follow up for high risk PE was 100%, intermediate high risk 69% (36/52), intermediate low risk 63% (97/154) and low risk 68% (55/81).

There were 143 (48%) provoked PE and 157 (52%) unprovoked PE events. Follow up rate for provoked PE was 51% (73/143) and 77% (121/157) for unprovoked PE.

Length of anticoagulation was reviewed in 163/194 (84%) patients, chronic thromboembolic pulmonary hypertension screening addressed in 126/194 (65%) and thrombophilia screening performed in 21/194 (11%).

Conclusions: A significant proportion of higher risk and unprovoked PE patients were not followed up. A designated PE MDT comprising of physicians, haematologists and specialist nurses to discuss all discharges would allow clinicians to streamline post PE follow up and improve outcomes.