Thromb Haemost
DOI: 10.1055/s-0040-1713170
Stroke, Systemic or Venous Thromboembolism
Georg Thieme Verlag KG Stuttgart · New York

Reasons for Hospitalization of Patients with Acute Pulmonary Embolism Based on the Hestia Decision Rule

1  Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, The Netherlands
2  Department of Internal Medicine, Haga Teaching Hospital, The Hague, The Netherlands
,
Paul L. den Exter
1  Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, The Netherlands
,
Wendy Zondag
1  Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, The Netherlands
,
Rolf Brouwer
3  Department of Internal Medicine, Reinier de Graaff Gasthuis, Delft, The Netherlands
,
Michiel Eijsvogel
4  Department of Pulmonary Medicine, Medisch Spectrum Twente, Enschede, The Netherlands
,
Marco J. Grootenboers
5  Department of Pulmonary Medicine, Amphia Hospital, Breda, The Netherlands
,
Laura M. Faber
6  Department of Pulmonary Medicine, Rode Kruis Hospital, Beverwijk, The Netherlands
,
Roxanne Heller-Baan
7  Department of Pulmonary Medicine, Ikazia Hospital, Rotterdam, The Netherlands
,
Herman M. A. Hofstee
8  Department of Internal Medicine, Haaglanden Medical Center, The Hague, The Netherlands
,
Antonio Iglesias del Sol
9  Department of Internal Medicine, Alrijne Hospital, Leiderdorp, The Netherlands
,
Marieke J. H. A. Kruip
10  Department of Haematology, Erasmus University Medical Center, Rotterdam, The Netherlands
,
Albert T. A. Mairuhu
2  Department of Internal Medicine, Haga Teaching Hospital, The Hague, The Netherlands
,
Christian F. Melissant
11  Department of Pulmonary Medicine, Spaarne Hospital, Hoofddorp, The Netherlands
,
Henny G. Peltenburg
12  Department of Internal Medicine, Groene Hart Hospital, Gouda, The Netherlands
,
Marcel A. van de Ree
13  Department of Internal Medicine, Diakonessenhuis, Utrecht, The Netherlands
,
Erik H. Serné
14  Department of Internal Medicine, VU Medical Center, Amsterdam, The Netherlands
,
Menno V. Huisman
1  Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, The Netherlands
,
1  Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, The Netherlands
,
on behalf of the Hestia/Vesta investigators› Author Affiliations
Further Information

Publication History

23 March 2020

05 May 2020

Publication Date:
28 June 2020 (online)

Abstract

Background The Hestia criteria can be used to select pulmonary embolism (PE) patients for outpatient treatment. The subjective Hestia criterion “medical/social reason for admission” allows the treating physician to consider any patient-specific circumstances in the final management decision. It is unknown how often and why this criterion is scored.

Methods This is a patient-level post hoc analysis of the combined Hestia and Vesta studies. The main outcomes were the frequency of all scored Hestia items in hospitalized patients and the explicit reason for scoring the subjective criterion. Hemodynamic parameters and computed tomography-assessed right ventricular (RV)/left ventricular (LV) ratio of those only awarded with the subjective criterion were compared with patients treated at home.

Results From the 1,166 patients screened, data were available for all 600 who were hospitalized. Most were hospitalized to receive oxygen therapy (45%); 227 (38%) were only awarded with the subjective criterion, of whom 51 because of “intermediate to intermediate-high risk PE.” Compared with patients with intermediate risk PE (RV/LV ratio > 1.0) treated at home (179/566, 32%), hospitalized patients with only the subjective criterion had a higher mean RV/LV ratio (mean difference +0.30, 95% confidence interval [CI] 0.19–0.41) and a higher heart rate (+18/min, 95% CI 10–25). No relevant differences were observed for other hemodynamic parameters.

Conclusion The most frequent reason for hospital admission was oxygen therapy. In the decision to award the subjective criterion as sole argument for admission, the severity of the RV overload and resulting hemodynamic response of the patient was taken into account rather than just abnormal RV/LV ratio.

Authors' Contributions

All authors contributed significantly to this manuscript and take responsibility for the analyses. S.H. and F.K. designed the study, interpreted the data, and drafted the manuscript. M.H. designed the study, interpreted the data, and critically revised the manuscript for important intellectual content.