Management of pulmonary embolism in the home.
OBJECTIVE
To describe the characteristics, outcomes and treatment complications of patients with pulmonary embolism (PE) who were treated at home and as outpatients in an ambulatory care program.


METHODS
Retrospective descriptive study of patients with PE who were treated in the ambulatory care unit during 2003. Ambulatory care unit data and medical record information were reviewed. Data collected included demographic and clinical data, standard clinical indicators of unplanned admission during treatment program, incidence of major bleeding, recurrent venous thromboembolism (VTE), and death within 3 months of admission into the ambulatory care program.


RESULTS
130 patients with PE were treated: 46% were treated totally as outpatients and 54% as early discharge patients. Mean age was 66.4 years; 61% were women. The program was successfully completed for 89% of patients; one patient was lost to follow-up. There were three episodes of major bleeding (2%; 95% CI, 0.5%-7%), all in patients aged > 70 years. Four patients died (3%; 95% CI, 0.8%-8%) within 3 months of admission into the program, but none in the first week, no death being directly attributable to PE. There were seven episodes of recurrent VTE (5%; 95% CI, 2%-11%).


CONCLUSIONS
Appropriately selected patients with sub-massive PE can be treated as outpatients and in the home. Although the outcome is good in most patients, a significant proportion will require admission, emphasising the need for a well defined protocol and close medical supervision. Further study will more closely define at-risk patients and refine the care pathways.
Ong
Bin S
BS
Department of Ambulatory Care, Bankstown-Lidcombe Hospital, Locked Mail Bag 1600, Bankstown, NSW 2200, Australia. bin.ong@swsahs.nsw.gov.au
Karr
Margaret A
MA
Chan
Daniel K Y
DK
Frankel
Anthony
A
Shen
Qing
Q
D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care / Q000706:statistics & numerical data; D005260:Female; D006470:Hemorrhage / Q000209:etiology; D006699:Home Care Services / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D009517:New South Wales; D010043:Outcome and Process Assessment, Health Care; D011655:Pulmonary Embolism / Q000150:complications / Q000451:nursing*; D012008:Recurrence; D012189:Retrospective Studies; D017678:Sex Distribution; D016019:Survival Analysis