The HOME-PE study comparing triaging strategies for outpatient care of normotensive patients with acute pulmonary embolism, found the pragmatic HESTIA method recommended by U.S. guidelines was noninferior to use of the simplified Pulmonary Embolism Severity Index (sPESI) score recommended by European guidelines when it came to the composite endpoint of recurrent venous thromboembolism (VTE), major bleeding and death. The findings were presented at ESC Congress 2020.

Researchers led by Pierre-Marie Roy, MD, of the University Hospital of Angers, France, randomized 1,974 patients presenting to the emergency department with acute pulmonary embolism at 26 hospitals in France, Belgium, the Netherlands and Switzerland to either a HESTIA or sPESI triage group. All patients had normal blood pressure. The primary outcome was a composite of recurrent VTE, major bleeding, and all-cause death within 30 days.

Patients randomized to the sPESI group were eligible for outpatient care if the score was 0; otherwise they were hospitalized. Patients randomized to the HESTIA group were eligible for outpatient care if all 11 criteria were negative; otherwise they were hospitalized. Results showed the primary outcome occurred in 3.8% of patients in the HESTIA group and 3.6% of patients in the sPESI group (p=0.005). Researchers did note that a greater proportion of patients were eligible for home care using sPESI (48.4%) compared with HESTIA (39.4%). However, the doctor in charge of the patient overruled sPESI more often than HESTIA. Across both groups, a similar proportion of patients were discharged within 24 hours for home treatment and all patients managed at home had a low rate of complications.

"These results support outpatient management of acute pulmonary embolism patients using either the HESTIA method or the sPESI score with the option for physicians to override the decision," Roy said. "In hospitals organized for outpatient management, both triaging strategies enable more than a third of pulmonary embolism patients to be managed at home with a low rate of complications."

Clinical Topics: Vascular Medicine

Keywords: ESC Congress, ESC20, Pulmonary Embolism

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