A multidisciplinary pulmonary embolism response team (PERT): first experience from a single center in Germany
Background Over the last few years, the concept of multidisciplinary pulmonary embolism response teams (PERTs) has emerged to encounter the increasing variety and complexity in managing acute pulmonary embolism (PE). Purpose To investigate PERT's composition and added clinical value in a univer...
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| Veröffentlicht in: | Clinical research in cardiology 2024-04, Vol.113 (4), p.581-590 |
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| creator | Sagoschen, Ingo Scibior, Barbara Farmakis, Ioannis T. Keller, Karsten Graafen, Dirk Griemert, Eva-Verena Vosseler, Markus Treede, Hendrik Münzel, Thomas Knorr, Maike Gori, Tommaso Konstantinides, Stavros Hobohm, Lukas |
| description | Background
Over the last few years, the concept of multidisciplinary pulmonary embolism response teams (PERTs) has emerged to encounter the increasing variety and complexity in managing acute pulmonary embolism (PE).
Purpose
To investigate PERT's composition and added clinical value in a university center in Germany.
Methods
Over 4 years (01/2019–11/2022), patients with confirmed PE were enrolled in a prospective single-center cohort study (PERT Mainz). We investigated the composition of PERT and compared, after propensity score matching, patients with acute PE before and after the initiation of PERT at our Medical University Centre. The primary outcome was in-hospital PE-related mortality.
Results
From 2019 to 2022, 88 patients with acute PE with a PERT decision were registered. Of those, 13 (14.8%) patients died during the in-hospital stay. Patients evaluated by a PERT had a median age of 68; 48.9% were females, and 21.7% suffered from malignancy. Right ventricular dysfunction was present in 76.1% of all patients. In total, 42.0% were classified as intermediate–high-risk PE and 11.4% as high-risk PE. First PERT contact mainly originated from emergency departments (33.3%) and intensive care units (30.0%), followed by chest pain units (21.3%) and regular wards (12.0%). The participation rate of medical specialties demonstrated that cardiologists (100%) or cardiac/vascular surgeons (98.6%) were included in almost all PERT consultations, followed by radiologists (95.9%) and anesthesiologists (87.8%). Compared to the PERT era, more patients in the pre-PERT era were classified as simplified pulmonary embolism severity index (sPESI) ≥ 1 (78.4% vs 71.6%) and as high-risk PE according to ESC 2019 guidelines (18.2% vs. 11.4%). In the pre-PERT era, low- and intermediate-low patients with PE received more frequently advanced reperfusion therapies such as systemic thrombolysis or surgical embolectomy compared to the PERT era (10.7% vs. 2.5%). Patients in the pre-PERT were found to have a considerably higher all-cause mortality and PE-related mortality rate (31.8% vs. 14.8%) compared to patients in the PERT era (22.7% vs. 13.6%). After propensity matching (1:1) by including parameters as age, sex, sPESI, and ESC risk classes, univariate regression analyses demonstrated that the PE management based on a PERT decision was associated with lower risk of all-cause mortality (OR, 0.37 [95%CI 0.18–0.77];
p =
0.009). For PE-related mortality, a tendency for reduction was obs |
| doi_str_mv | 10.1007/s00392-023-02364-4 |
| format | Article |
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Over the last few years, the concept of multidisciplinary pulmonary embolism response teams (PERTs) has emerged to encounter the increasing variety and complexity in managing acute pulmonary embolism (PE).
Purpose
To investigate PERT's composition and added clinical value in a university center in Germany.
Methods
Over 4 years (01/2019–11/2022), patients with confirmed PE were enrolled in a prospective single-center cohort study (PERT Mainz). We investigated the composition of PERT and compared, after propensity score matching, patients with acute PE before and after the initiation of PERT at our Medical University Centre. The primary outcome was in-hospital PE-related mortality.
Results
From 2019 to 2022, 88 patients with acute PE with a PERT decision were registered. Of those, 13 (14.8%) patients died during the in-hospital stay. Patients evaluated by a PERT had a median age of 68; 48.9% were females, and 21.7% suffered from malignancy. Right ventricular dysfunction was present in 76.1% of all patients. In total, 42.0% were classified as intermediate–high-risk PE and 11.4% as high-risk PE. First PERT contact mainly originated from emergency departments (33.3%) and intensive care units (30.0%), followed by chest pain units (21.3%) and regular wards (12.0%). The participation rate of medical specialties demonstrated that cardiologists (100%) or cardiac/vascular surgeons (98.6%) were included in almost all PERT consultations, followed by radiologists (95.9%) and anesthesiologists (87.8%). Compared to the PERT era, more patients in the pre-PERT era were classified as simplified pulmonary embolism severity index (sPESI) ≥ 1 (78.4% vs 71.6%) and as high-risk PE according to ESC 2019 guidelines (18.2% vs. 11.4%). In the pre-PERT era, low- and intermediate-low patients with PE received more frequently advanced reperfusion therapies such as systemic thrombolysis or surgical embolectomy compared to the PERT era (10.7% vs. 2.5%). Patients in the pre-PERT were found to have a considerably higher all-cause mortality and PE-related mortality rate (31.8% vs. 14.8%) compared to patients in the PERT era (22.7% vs. 13.6%). After propensity matching (1:1) by including parameters as age, sex, sPESI, and ESC risk classes, univariate regression analyses demonstrated that the PE management based on a PERT decision was associated with lower risk of all-cause mortality (OR, 0.37 [95%CI 0.18–0.77];
p =
0.009). For PE-related mortality, a tendency for reduction was observed (OR, 0.54 [95%CI 0.24–1.18];
p =
0.121).
Conclusion
PERT implementation was associated with a lower risk of all-cause mortality rate in patients with acute PE. Large prospective studies are needed further to explore the impact of PERTs on clinical outcomes.
Graphical abstract</description><identifier>ISSN: 1861-0684</identifier><identifier>EISSN: 1861-0692</identifier><identifier>DOI: 10.1007/s00392-023-02364-4</identifier><identifier>PMID: 38112742</identifier><language>eng</language><publisher>Berlin/Heidelberg: Springer Berlin Heidelberg</publisher><subject>Cardiology ; Cohort Studies ; Composition ; Decision analysis ; Embolism ; Embolisms ; Emergency medical care ; Emergency medical services ; Female ; Hospitals ; Humans ; Intensive care units ; Length of Stay ; Male ; Malignancy ; Matching ; Medicine ; Medicine & Public Health ; Mortality ; Original Paper ; Patient Care Team ; Patients ; Prospective Studies ; Pulmonary Embolism - diagnosis ; Pulmonary Embolism - epidemiology ; Pulmonary Embolism - therapy ; Pulmonary embolisms ; Regression analysis ; Reperfusion ; Risk ; Thrombolysis ; Thrombolytic Therapy</subject><ispartof>Clinical research in cardiology, 2024-04, Vol.113 (4), p.581-590</ispartof><rights>The Author(s) 2023</rights><rights>2023. The Author(s).</rights><rights>The Author(s) 2023. This work is published under http://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c475t-6fcfe60bdd578047775460d99b9cb4f2f486b0408656732f7c282163621088633</citedby><cites>FETCH-LOGICAL-c475t-6fcfe60bdd578047775460d99b9cb4f2f486b0408656732f7c282163621088633</cites><orcidid>0000-0002-4312-0366</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00392-023-02364-4$$EPDF$$P50$$Gspringer$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00392-023-02364-4$$EHTML$$P50$$Gspringer$$Hfree_for_read</linktohtml><link.rule.ids>230,314,780,784,885,27924,27925,41488,42557,51319</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/38112742$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Sagoschen, Ingo</creatorcontrib><creatorcontrib>Scibior, Barbara</creatorcontrib><creatorcontrib>Farmakis, Ioannis T.</creatorcontrib><creatorcontrib>Keller, Karsten</creatorcontrib><creatorcontrib>Graafen, Dirk</creatorcontrib><creatorcontrib>Griemert, Eva-Verena</creatorcontrib><creatorcontrib>Vosseler, Markus</creatorcontrib><creatorcontrib>Treede, Hendrik</creatorcontrib><creatorcontrib>Münzel, Thomas</creatorcontrib><creatorcontrib>Knorr, Maike</creatorcontrib><creatorcontrib>Gori, Tommaso</creatorcontrib><creatorcontrib>Konstantinides, Stavros</creatorcontrib><creatorcontrib>Hobohm, Lukas</creatorcontrib><title>A multidisciplinary pulmonary embolism response team (PERT): first experience from a single center in Germany</title><title>Clinical research in cardiology</title><addtitle>Clin Res Cardiol</addtitle><addtitle>Clin Res Cardiol</addtitle><description>Background
Over the last few years, the concept of multidisciplinary pulmonary embolism response teams (PERTs) has emerged to encounter the increasing variety and complexity in managing acute pulmonary embolism (PE).
Purpose
To investigate PERT's composition and added clinical value in a university center in Germany.
Methods
Over 4 years (01/2019–11/2022), patients with confirmed PE were enrolled in a prospective single-center cohort study (PERT Mainz). We investigated the composition of PERT and compared, after propensity score matching, patients with acute PE before and after the initiation of PERT at our Medical University Centre. The primary outcome was in-hospital PE-related mortality.
Results
From 2019 to 2022, 88 patients with acute PE with a PERT decision were registered. Of those, 13 (14.8%) patients died during the in-hospital stay. Patients evaluated by a PERT had a median age of 68; 48.9% were females, and 21.7% suffered from malignancy. Right ventricular dysfunction was present in 76.1% of all patients. In total, 42.0% were classified as intermediate–high-risk PE and 11.4% as high-risk PE. First PERT contact mainly originated from emergency departments (33.3%) and intensive care units (30.0%), followed by chest pain units (21.3%) and regular wards (12.0%). The participation rate of medical specialties demonstrated that cardiologists (100%) or cardiac/vascular surgeons (98.6%) were included in almost all PERT consultations, followed by radiologists (95.9%) and anesthesiologists (87.8%). Compared to the PERT era, more patients in the pre-PERT era were classified as simplified pulmonary embolism severity index (sPESI) ≥ 1 (78.4% vs 71.6%) and as high-risk PE according to ESC 2019 guidelines (18.2% vs. 11.4%). In the pre-PERT era, low- and intermediate-low patients with PE received more frequently advanced reperfusion therapies such as systemic thrombolysis or surgical embolectomy compared to the PERT era (10.7% vs. 2.5%). Patients in the pre-PERT were found to have a considerably higher all-cause mortality and PE-related mortality rate (31.8% vs. 14.8%) compared to patients in the PERT era (22.7% vs. 13.6%). After propensity matching (1:1) by including parameters as age, sex, sPESI, and ESC risk classes, univariate regression analyses demonstrated that the PE management based on a PERT decision was associated with lower risk of all-cause mortality (OR, 0.37 [95%CI 0.18–0.77];
p =
0.009). For PE-related mortality, a tendency for reduction was observed (OR, 0.54 [95%CI 0.24–1.18];
p =
0.121).
Conclusion
PERT implementation was associated with a lower risk of all-cause mortality rate in patients with acute PE. Large prospective studies are needed further to explore the impact of PERTs on clinical outcomes.
Graphical abstract</description><subject>Cardiology</subject><subject>Cohort Studies</subject><subject>Composition</subject><subject>Decision analysis</subject><subject>Embolism</subject><subject>Embolisms</subject><subject>Emergency medical care</subject><subject>Emergency medical services</subject><subject>Female</subject><subject>Hospitals</subject><subject>Humans</subject><subject>Intensive care units</subject><subject>Length of Stay</subject><subject>Male</subject><subject>Malignancy</subject><subject>Matching</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Mortality</subject><subject>Original Paper</subject><subject>Patient Care Team</subject><subject>Patients</subject><subject>Prospective Studies</subject><subject>Pulmonary Embolism - diagnosis</subject><subject>Pulmonary Embolism - epidemiology</subject><subject>Pulmonary Embolism - therapy</subject><subject>Pulmonary embolisms</subject><subject>Regression analysis</subject><subject>Reperfusion</subject><subject>Risk</subject><subject>Thrombolysis</subject><subject>Thrombolytic Therapy</subject><issn>1861-0684</issn><issn>1861-0692</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><sourceid>C6C</sourceid><sourceid>EIF</sourceid><recordid>eNp9kUtv1TAQhSMEog_4AyyQJTZlERg7jh9sqqpqC1IlECprK4_xxVVsBztB9N_j21sujwULyyPNN8dzfKrqBYU3FEC-zQCNZjWwZnsEr_mj6pAqQWsQmj3e14ofVEc53wK0FBr-tDpoFKVMcnZY-TPi12lxo8uDmycXunRH5nXy8b5C38fJZU8S5jmGjGTBzpOTTxefb16_I9alvBD8MWNyGAYkNkVPOpJd2ExIBgwLJuICucLku3D3rHpiuynj84f7uPpyeXFz_r6-_nj14fzsuh64bJda2MGigH4cW6mASylbLmDUutdDzy2zXIkeOCjRCtkwKwemGBWNYBSUEk1zXJ3udOe19zhu90jdZObkfHFlYufM353gvppN_G4o6JZrLovCyYNCit9WzIvx5YdwmrqAcc2GaeC0lUyqgr76B72NawrFX6GEpkUNdKHYjhpSzDmh3W9DwWzjNLs4TYnS3MdpeBl6-aeP_civ_ArQ7IBcWmGD6ffb_5H9CfPUqsM</recordid><startdate>20240401</startdate><enddate>20240401</enddate><creator>Sagoschen, Ingo</creator><creator>Scibior, Barbara</creator><creator>Farmakis, Ioannis T.</creator><creator>Keller, Karsten</creator><creator>Graafen, Dirk</creator><creator>Griemert, Eva-Verena</creator><creator>Vosseler, Markus</creator><creator>Treede, Hendrik</creator><creator>Münzel, Thomas</creator><creator>Knorr, Maike</creator><creator>Gori, Tommaso</creator><creator>Konstantinides, Stavros</creator><creator>Hobohm, Lukas</creator><general>Springer Berlin Heidelberg</general><general>Springer Nature B.V</general><scope>C6C</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>8FD</scope><scope>FR3</scope><scope>K9.</scope><scope>M7Z</scope><scope>P64</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0002-4312-0366</orcidid></search><sort><creationdate>20240401</creationdate><title>A multidisciplinary pulmonary embolism response team (PERT): first experience from a single center in Germany</title><author>Sagoschen, Ingo ; Scibior, Barbara ; Farmakis, Ioannis T. ; Keller, Karsten ; Graafen, Dirk ; Griemert, Eva-Verena ; Vosseler, Markus ; Treede, Hendrik ; Münzel, Thomas ; Knorr, Maike ; Gori, Tommaso ; Konstantinides, Stavros ; Hobohm, Lukas</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c475t-6fcfe60bdd578047775460d99b9cb4f2f486b0408656732f7c282163621088633</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><topic>Cardiology</topic><topic>Cohort Studies</topic><topic>Composition</topic><topic>Decision analysis</topic><topic>Embolism</topic><topic>Embolisms</topic><topic>Emergency medical care</topic><topic>Emergency medical services</topic><topic>Female</topic><topic>Hospitals</topic><topic>Humans</topic><topic>Intensive care units</topic><topic>Length of Stay</topic><topic>Male</topic><topic>Malignancy</topic><topic>Matching</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Mortality</topic><topic>Original Paper</topic><topic>Patient Care Team</topic><topic>Patients</topic><topic>Prospective Studies</topic><topic>Pulmonary Embolism - diagnosis</topic><topic>Pulmonary Embolism - epidemiology</topic><topic>Pulmonary Embolism - therapy</topic><topic>Pulmonary embolisms</topic><topic>Regression analysis</topic><topic>Reperfusion</topic><topic>Risk</topic><topic>Thrombolysis</topic><topic>Thrombolytic Therapy</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Sagoschen, Ingo</creatorcontrib><creatorcontrib>Scibior, Barbara</creatorcontrib><creatorcontrib>Farmakis, Ioannis T.</creatorcontrib><creatorcontrib>Keller, Karsten</creatorcontrib><creatorcontrib>Graafen, Dirk</creatorcontrib><creatorcontrib>Griemert, Eva-Verena</creatorcontrib><creatorcontrib>Vosseler, Markus</creatorcontrib><creatorcontrib>Treede, Hendrik</creatorcontrib><creatorcontrib>Münzel, Thomas</creatorcontrib><creatorcontrib>Knorr, Maike</creatorcontrib><creatorcontrib>Gori, Tommaso</creatorcontrib><creatorcontrib>Konstantinides, Stavros</creatorcontrib><creatorcontrib>Hobohm, Lukas</creatorcontrib><collection>Springer Nature OA Free Journals</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Technology Research Database</collection><collection>Engineering Research Database</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Biochemistry Abstracts 1</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Clinical research in cardiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Sagoschen, Ingo</au><au>Scibior, Barbara</au><au>Farmakis, Ioannis T.</au><au>Keller, Karsten</au><au>Graafen, Dirk</au><au>Griemert, Eva-Verena</au><au>Vosseler, Markus</au><au>Treede, Hendrik</au><au>Münzel, Thomas</au><au>Knorr, Maike</au><au>Gori, Tommaso</au><au>Konstantinides, Stavros</au><au>Hobohm, Lukas</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>A multidisciplinary pulmonary embolism response team (PERT): first experience from a single center in Germany</atitle><jtitle>Clinical research in cardiology</jtitle><stitle>Clin Res Cardiol</stitle><addtitle>Clin Res Cardiol</addtitle><date>2024-04-01</date><risdate>2024</risdate><volume>113</volume><issue>4</issue><spage>581</spage><epage>590</epage><pages>581-590</pages><issn>1861-0684</issn><eissn>1861-0692</eissn><abstract>Background
Over the last few years, the concept of multidisciplinary pulmonary embolism response teams (PERTs) has emerged to encounter the increasing variety and complexity in managing acute pulmonary embolism (PE).
Purpose
To investigate PERT's composition and added clinical value in a university center in Germany.
Methods
Over 4 years (01/2019–11/2022), patients with confirmed PE were enrolled in a prospective single-center cohort study (PERT Mainz). We investigated the composition of PERT and compared, after propensity score matching, patients with acute PE before and after the initiation of PERT at our Medical University Centre. The primary outcome was in-hospital PE-related mortality.
Results
From 2019 to 2022, 88 patients with acute PE with a PERT decision were registered. Of those, 13 (14.8%) patients died during the in-hospital stay. Patients evaluated by a PERT had a median age of 68; 48.9% were females, and 21.7% suffered from malignancy. Right ventricular dysfunction was present in 76.1% of all patients. In total, 42.0% were classified as intermediate–high-risk PE and 11.4% as high-risk PE. First PERT contact mainly originated from emergency departments (33.3%) and intensive care units (30.0%), followed by chest pain units (21.3%) and regular wards (12.0%). The participation rate of medical specialties demonstrated that cardiologists (100%) or cardiac/vascular surgeons (98.6%) were included in almost all PERT consultations, followed by radiologists (95.9%) and anesthesiologists (87.8%). Compared to the PERT era, more patients in the pre-PERT era were classified as simplified pulmonary embolism severity index (sPESI) ≥ 1 (78.4% vs 71.6%) and as high-risk PE according to ESC 2019 guidelines (18.2% vs. 11.4%). In the pre-PERT era, low- and intermediate-low patients with PE received more frequently advanced reperfusion therapies such as systemic thrombolysis or surgical embolectomy compared to the PERT era (10.7% vs. 2.5%). Patients in the pre-PERT were found to have a considerably higher all-cause mortality and PE-related mortality rate (31.8% vs. 14.8%) compared to patients in the PERT era (22.7% vs. 13.6%). After propensity matching (1:1) by including parameters as age, sex, sPESI, and ESC risk classes, univariate regression analyses demonstrated that the PE management based on a PERT decision was associated with lower risk of all-cause mortality (OR, 0.37 [95%CI 0.18–0.77];
p =
0.009). For PE-related mortality, a tendency for reduction was observed (OR, 0.54 [95%CI 0.24–1.18];
p =
0.121).
Conclusion
PERT implementation was associated with a lower risk of all-cause mortality rate in patients with acute PE. Large prospective studies are needed further to explore the impact of PERTs on clinical outcomes.
Graphical abstract</abstract><cop>Berlin/Heidelberg</cop><pub>Springer Berlin Heidelberg</pub><pmid>38112742</pmid><doi>10.1007/s00392-023-02364-4</doi><tpages>10</tpages><orcidid>https://orcid.org/0000-0002-4312-0366</orcidid><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1861-0684 |
| ispartof | Clinical research in cardiology, 2024-04, Vol.113 (4), p.581-590 |
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| language | eng |
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| source | MEDLINE; SpringerLink Journals - AutoHoldings |
| subjects | Cardiology Cohort Studies Composition Decision analysis Embolism Embolisms Emergency medical care Emergency medical services Female Hospitals Humans Intensive care units Length of Stay Male Malignancy Matching Medicine Medicine & Public Health Mortality Original Paper Patient Care Team Patients Prospective Studies Pulmonary Embolism - diagnosis Pulmonary Embolism - epidemiology Pulmonary Embolism - therapy Pulmonary embolisms Regression analysis Reperfusion Risk Thrombolysis Thrombolytic Therapy |
| title | A multidisciplinary pulmonary embolism response team (PERT): first experience from a single center in Germany |
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