Pulmonary Vascular Disease: Pulmonary Embolism: Assessment and Outcomes |

Follow-up of Hospitalized Patients With Acute Pulmonary Embolism and Documented Pulmonary Hypertension: A Retrospective Review FREE TO VIEW

Mathieu Saint-Pierre, MD; Karlo Hockmann, MD; Christine D Arsigny, MD
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Queen's University, Kingston, ON, Canada

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;150(4_S):1156A. doi:10.1016/j.chest.2016.08.1265
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SESSION TITLE: Pulmonary Embolism: Assessment and Outcomes

SESSION TYPE: Original Investigation Slide

PRESENTED ON: Sunday, October 23, 2016 at 04:30 PM - 05:30 PM

PURPOSE: Echocardiography is often performed in patients admitted with a diagnosis of pulmonary embolism (PE), either as a part of the diagnostic workup or as a prognostic tool. The most recent Canadian guidelines recommend that clinical and diagnostic follow-up be carried out if pulmonary hypertension (PH) is documented at the time of an acute PE, as some patients will develop chronic thromboembolic pulmonary hypertension (CTEPH). We completed a chart review to determine the frequency of patients having a repeat echocardiogram after discharge from hospital, and to assess referral rates to our PH clinic.

METHODS: With ethics approval, all adult patients admitted to Kingston General Hospital from January 2013 to June 2015 with a diagnosis of PE (as main diagnosis or complication arising during hospitalization) were identified. Data collected included age, gender, baseline prognostic variables, diagnostic testing, echocardiography findings, therapies received and PH clinic referrals.

RESULTS: A total of 364 admissions were identified, involving 356 patients. Of these, 54% were women; median age was of 67 years (range 19 to 96). Most PE were diagnosed by computed tomography (77%). 5% of admissions received thrombolysis, and 7% had an inferior vena cava filter inserted. Median length of stay was of 10 days, and all-cause inpatient mortality was 10%. Echocardiogram was performed on 192 admissions (53%). Elevated pulmonary artery systolic pressure (PASP) and/or presence of right ventricular dysfunction were documented in 64% (123/192); these echocardiography findings were not present before the diagnosis of PE in 88% of cases. 44% (47/107) of surviving patients with an elevated PASP and/or right ventricular dysfunction had a follow-up study performed after discharge (mean interval 4.5 months), and 43% of these had persistent abnormalities. Only 9% with suspected PH based on in-hospital echocardiography were referred to the PH clinic; this rose to 20% when still present on a repeat study post-discharge. 50% of those referred to PH clinic were found to have CTEPH.

CONCLUSIONS: The majority of patients (56%) found to have an elevated PASP and/or right ventricular dysfunction after an acute PE did not have a follow-up echocardiogram, as recommended by national guidelines. Furthermore, PH clinic referral rates were quite low at our institution, even when persistent abnormalities were seen on a repeat echocardiogram. Of those referred, 50% were found to have CTEPH.

CLINICAL IMPLICATIONS: Early diagnosis of CTEPH is of the utmost importance as extremely low survival rates have previously been reported. Our study would suggest that many patients are not being appropriately followed after an acute PE, which may significantly decrease CTEPH diagnosis rates.

DISCLOSURE: The following authors have nothing to disclose: Mathieu Saint-Pierre, Karlo Hockmann, Christine D Arsigny

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