Impact of a pulmonary embolism response team initiative on hospital mortality of patients with bilateral pulmonary embolism

Introduction: Pulmonary embolism (PE) response teams (PERT) for the management of high-risk PE (HR-PE) and intermediate-high risk PE (IHR-PE) are encouraged in PE guidelines. We aimed to assess the impact of a PERT initiative on mortality in these groups of patients, compared with standard care.Methods: We conducted a prospective, single-center registry, including consecutive patients with HR-PE and IHR-PE with PERT activation from February-2018 to December-2020 (PERT group, n = 78 patients) and compared it with an historic cohort of patients admitted to our hospital in a previous 2-year period (2014-2016), managed with standard of care (SC-group, n = 108 patients).Results: Patients in the PERT group were younger and less comorbid. The risk profile at admission and the percentage of HR-PE was similar in both cohorts (13% in SC-group and 14% in PERT-group, p = 0.82). Reperfusion therapy was more frequently indicated in PERT-group (24.4% vs 10.2%, p = 0.01), with no differences in fibrinolysis treatment, while catheter-directed therapy (CDT) was more frequent in PERT group (16.7% vs 1.9%, p < 0.001). Reperfusion and CDT were associated with lower in-hospital mortality (2.9% vs 15.1%, p = 0.001 for reperfusion and 1.5% vs 16.5%, p = 0.001 for CDT). The primary outcome, 12-month mortality, was lower in the PERT-group (9% vs 22.2%, p = 0.02), There were no differences in 30-day readmissions. In multivariate analysis PERT activation was associated with lower mortality at 12 months (HR 0.25, 95% confidence interval 0.09-0.7, p = 0.008).Conclusion: A PERT initiative in patients with HR-PE and IHR-PE was associated with a significant reduc-tion in 12-month mortality compared with standard of care, and also with an increase in the use of reperfusion, especially catheter-directed therapies.& COPY; 2023 Elsevier Espan & SIM;a, S.L.U. All rights reserved.