open access

Vol 28, No 4 (2022)
Research paper
Published online: 2022-12-30
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In-hospital diagnostic strategies for acute pulmonary embolism — results of a single-center study based on the experience of a multi-profile clinical hospital

Urszula A. Szymańska1, Marcin Kurzyna2, Piotr Kułak1, Dariusz A. Kosior13
DOI: 10.5603/AA.2022.0014
·
Acta Angiologica 2022;28(4):154-160.
Affiliations
  1. Department of Cardiology and Hypertension with the Electrophysiological Lab, Central Research Hospital the Ministry of The Interior and Administration, Warsaw, Poland
  2. Department of Pulmonary Circulation and Thromboembolic Diseases, Medical Centre of Postgraduate Education, European Health Centre Otwock, Otwock, Poland
  3. Mossakowski Medical Research Institute, Polish Academy of Sciences, Warsaw, Poland

open access

Vol 28, No 4 (2022)
Original papers
Published online: 2022-12-30

Abstract

Introduction: Acute pulmonary embolism (APE) is the most severe clinical presentation of venous thromboembolism
(VTE) and inappropriate diagnostic strategies of APE lead to death or chronic thromboembolic
pulmonary hypertension.

Material and methods: In prospective manner we followed patients admitted to a tertiary clinical center
with APE proven with CT scan within the period of 24 months. We assessed diagnostic strategies of APE in
different clinical departments of Polish multi-profile hospital and their association with prognosis.

Results: A total number of 178 patients with APE were enrolled in the study, of which 56 patients were diagnosed
with APE in the emergency department (ED), 42 in cardiology departments, and 80 in other departments. No
significant differences in diagnostic strategies between departments were found. Adherence to ESC guidelines
was 56.1% and it was similar in compared departments (p = 0.648). The in-hospital mortality rate was 6.7%.
In the 6 month follow-up period 18.1% of the studied died. Coronary artery disease (p = 0.002), cancer
(p = 0.032), serious medical condition (p = 0.047), altered mental status (p = 0.032), CRP
(p = 0.006), and hemoglobin (p = 0.023) were identified as predictors of clinical deterioration. Risk factors
for in-hospital and 6-month mortality were congestive heart failure, serious medical condition, and systolic
blood pressure (p < 0.05). Immobility over 3 days and cancer were also identified as predictors of death within
6 months (p < 0.001). There was no association between the type of the department, clinical deterioration,
in-hospital, and 6-month mortality.

Conclusion: There is no difference in APE management and prognosis in different profile departments.

Abstract

Introduction: Acute pulmonary embolism (APE) is the most severe clinical presentation of venous thromboembolism
(VTE) and inappropriate diagnostic strategies of APE lead to death or chronic thromboembolic
pulmonary hypertension.

Material and methods: In prospective manner we followed patients admitted to a tertiary clinical center
with APE proven with CT scan within the period of 24 months. We assessed diagnostic strategies of APE in
different clinical departments of Polish multi-profile hospital and their association with prognosis.

Results: A total number of 178 patients with APE were enrolled in the study, of which 56 patients were diagnosed
with APE in the emergency department (ED), 42 in cardiology departments, and 80 in other departments. No
significant differences in diagnostic strategies between departments were found. Adherence to ESC guidelines
was 56.1% and it was similar in compared departments (p = 0.648). The in-hospital mortality rate was 6.7%.
In the 6 month follow-up period 18.1% of the studied died. Coronary artery disease (p = 0.002), cancer
(p = 0.032), serious medical condition (p = 0.047), altered mental status (p = 0.032), CRP
(p = 0.006), and hemoglobin (p = 0.023) were identified as predictors of clinical deterioration. Risk factors
for in-hospital and 6-month mortality were congestive heart failure, serious medical condition, and systolic
blood pressure (p < 0.05). Immobility over 3 days and cancer were also identified as predictors of death within
6 months (p < 0.001). There was no association between the type of the department, clinical deterioration,
in-hospital, and 6-month mortality.

Conclusion: There is no difference in APE management and prognosis in different profile departments.

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Keywords

6-month mortality; guidelines adherence; in-hospital mortality; pulmonary embolism

About this article
Title

In-hospital diagnostic strategies for acute pulmonary embolism — results of a single-center study based on the experience of a multi-profile clinical hospital

Journal

Acta Angiologica

Issue

Vol 28, No 4 (2022)

Article type

Research paper

Pages

154-160

Published online

2022-12-30

Page views

496

Article views/downloads

59

DOI

10.5603/AA.2022.0014

Bibliographic record

Acta Angiologica 2022;28(4):154-160.

Keywords

6-month mortality
guidelines adherence
in-hospital mortality
pulmonary embolism

Authors

Urszula A. Szymańska
Marcin Kurzyna
Piotr Kułak
Dariusz A. Kosior

References (11)
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  2. Goldhaber SZ, Elliott CG. Acute pulmonary embolism: part I: epidemiology, pathophysiology, and diagnosis. Circulation. 2003; 108(22): 2726–2729.
  3. Torbicki A, Perrier A, Konstantinides S, et al. GUIDELINES ON THE DIAGNOSIS AND MANAGEMENT OF ACUTE PULMONARY EMBOLISM. Ration Pharmacother Cardiol. 2009; 5(2): 103–122.
  4. Konstantinides SV, Torbicki A, Agnelli G, et al. Authors/Task Force Members, Authors/Task Force Members, Grupa Robocza Europejskiego Towarzystwa Kardiologicznego (ESC) do spraw rozpoznawania i postepowania w ostrej zatorowości płucnej, Task Force for the Diagnosis and Management of Acute Pulmonary Embolism of the European Society of Cardiology (ESC). 2014 ESC guidelines on the diagnosis and management of acute pulmonary embolism. Eur Heart J. 2014; 35(43): 3033–69, 3069a.
  5. Venkatesh AK, Kline JA, Courtney DM, et al. Evaluation of pulmonary embolism in the emergency department and consistency with a national quality measure: quantifying the opportunity for improvement. Arch Intern Med. 2012; 172(13): 1028–1032.
  6. Rehman A, Yelf E, Pearson J, et al. Compliance to clinical pathways in the management of suspected pulmonary embolus: are there cost implications? Intern Med J. 2017; 47(4): 458–461.
  7. Costantino MM, Randall G, Gosselin M, et al. CT angiography in the evaluation of acute pulmonary embolus. AJR Am J Roentgenol. 2008; 191(2): 471–474.
  8. Roy PM, Meyer G, Vielle B, et al. EMDEPU Study Group. Appropriateness of diagnostic management and outcomes of suspected pulmonary embolism. Ann Intern Med. 2006; 144(3): 157–164.
  9. Ng BJH, Lindstrom S. Study of compliance with a clinical pathway for suspected pulmonary embolism. Intern Med J. 2011; 41(3): 251–257.
  10. Spirk D, Husmann M, Hayoz D, et al. Predictors of in-hospital mortality in elderly patients with acute venous thrombo-embolism: the SWIss Venous ThromboEmbolism Registry (SWIVTER). Eur Heart J. 2012; 33(7): 921–926.
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