Katerberg, B. (Bianca) (2014) The HOLY MOLI study: HOspital at home puLmonarY eMbOLIsm. Evaluation of safety and quality of out-of-hospital treatment of acute Pulmonary Embolism. thesis, Medicine.
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Abstract
Introduction Acute pulmonary embolism (PE) is still commonly considered a possibly life-threatening condition requiring in-hospital care. And even though evidence on safe out-patient treatment of selected low-risk patients with acute PE is accumulating, no clear guidelines have been established on this matter. Our aim is to assess the safety of out-patient treatment of acute PE in low-risk patients as determined by the Pulmonary Embolism Severity Index (PESI). Additionally, we will compare patients’ satisfaction with treatment between in-patients and out-patients. Methods In this prospective cohort study, all patients who presented with acute PE between 1 July 2008 and 30 June 2013 were categorized as low-risk or high-risk using the PESI. All low-risk patients (PESI class I or II) were assessed and if possible included in the study and subsequently discharged < 24 hours after presentation and treated in an hospital-at-home setting with subcutaneous tinzaparin (Innohep©) with 5 days of daily home-nurse care. Primary outcomes are all-cause mortality, recurrent venous thromboembolism (VTE) and major bleeding within 4 weeks and 6 months. Secondary outcomes were quality of life measured in SF-36 scores after 4 weeks and 6 months, and progress of the recovery measured in VAS-scores for pain and dyspnea at multiple times during the recovery. Additionally, we retrospectively assessed patients’ satisfaction with their treatment by sending them questionnaires (PACT-Q2) after they had completed the treatment, we did this for out-patients as well as for in-patients so that we could compare the two groups. Lastly, we assessed the cost savings of the out-of-hospital treatment in comparison to in-hospital treatment. Results A total of 250 patients were included in this study. The 30-day and 6-month mortality rate were 0.4% (n=1) and none of the patients (0%) experienced a recurrent VTE. A total of 8 (3.2%) bleeding episodes were documented within 30 days, and 16 (6.4%) within 6 months. The readmission rate within 30 days was 2.4% (n=6) and 9.6% (n=24) within 6 months, of these respectively 2.0% (n=5) and 3.6% (n=9) was related to the PE or treatment for the PE. We found a significant improvement in VAS-scores for pain and dyspnea, between several relevant moments during the treatment. Additionally, there was a significant improvement in quality of life for 6 out of 8 domains, measured as an SF-36 score. Median patient satisfaction measured as a grade (0-10) was 8.0 and measured as PACT-Q score (0-100) was 87 for the outpatient group, this did not significantly differ from the inpatient group. Conclusion Our study shows that outpatient treatment of PE, in patients with low risk on adverse events identified using the PESI classification, is safe, effective en cost saving, without having to concise in quality and patient satisfaction.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Berg, dr. J.W.K. van den and Pulmonology and Isala Klinieken Zwolle |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 11:01 |
| Last Modified: | 25 Jun 2020 11:01 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/2126 |
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