Safety, feasibility and patient reported outcome measures of outpatient treatment of pulmonary embolism

Abstract Background Despite growing evidence on safe and feasible outpatient treatment for acute pulmonary embolism (PE), the majority of patients is still treated in an inpatient setting. This is probably due to a lack of clear guidelines on this subject. Objectives To evaluate safety and patient reported outcome measures (PROM) on outpatient treatment of acute PE. Methods We conducted a prospective cohort study. 250 patients presenting with acute PE and Pulmonary Embolism Severity Index (PESI) class I or II were enrolled. Safety of outpatient treatment was assessed by measuring all-cause mortality, recurrent venous thromboembolism (VTE) and episodes of relevant bleeding, with a follow-up period of four weeks and six months. Additionally, PROM's on outpatient treatment were evaluated by repeatedly measuring VAS-scores for pain and dyspnea during the recovery, and by assessing the improvement in SF-36 scores between admission and after six months. Results We found an all-cause mortality rate of 0.4% (95% CI 0.07–2.23), rate of recurrent VTE of 0% (95% CI 0–1.51) and rate of relevant bleeding episodes of 6.4% (95% CI 3.98–10.14). VAS-scores improved significantly during the first 24-h after admission, and continued to improve significantly after five days of home treatment. SF-36 scores on 6 out of 8 domains improved significantly between admission and after six months. Conclusions Our study shows that outpatient treatment is safe in selected low-risk patients based on their PESI score. Additionally, our data on patient reported outcome measures support the presumption of a good course of recovery during outpatient treatment.