OC 71.2 - Discharging cancer patients with acute pulmonary embolism from the emergency department: a multicenter cohort study

Wednesday, June 28, 2023

10:30 – 10:45 ET

Room: 710A

Session Available As: On-Demand

Presenting Author(s)

NG

Noori A.M Guman, MD

PhD Student
Dept. of Vascular Medicine, Amsterdam UMC location AMC, University of Amsterdam, Amsterdam, The Netherlands
Amsterdam, Noord-Holland, Netherlands

Co-Author(s)

Fleur H.J. Kaptein, MD

PhD student
Department of Medicine - Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, The Netherlands
Leiden, Zuid-Holland, Netherlands
SL

Susan Lohle

Medical student
Dept. of Vascular Medicine, Amsterdam UMC location AMC, University of Amsterdam, Amsterdam, The Netherlands
Amsterdam, Noord-Holland, Netherlands
AM

Albert T.A. Mairuhu

MD, PhD
Department of Vascular Medicine, Haga Hospital
the Hague, Zuid-Holland, Netherlands
Erik Klok, MD, PhD, FESC

Leiden University Medical Center
MH

Menno V. Huisman

MD, PhD
Department of Medicine - Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands
Leiden, Zuid-Holland, Netherlands
PK

Pieter W. Kamphuisen

MD
Tergooi MC and Amsterdam University Medical Centers
Hilversum, Noord-Holland, Netherlands
Nick van Es, MD PhD (he/him/his)

MD
Department of Vascular Medicine, Amsterdam University Medical Center, Amsterdam, The Netherlands
Amsterdam, Noord-Holland, Netherlands

Background: It is unclear how often cancer patients with acute symptomatic or incidental pulmonary embolism (PE) are discharged from the emergency department (ED), what the determinants of discharge are, and whether discharge from the ED is safe in this setting.

Aims: To assess the treatment setting (hospitalization vs discharge from the ED), potential determinants for discharge from the ED, and safety outcomes in ambulatory cancer patients with acute symptomatic and incidental PE.

Methods: Cancer patients diagnosed with PE between August 2017 and May 2021 were included in a Dutch multicenter retrospective cohort study. The primary outcomes were discharge from the ED and hospitalization. Safety outcomes were 14-day mortality and PE-related readmission (new PE-related hospital admission < 7 days after discharge).

Results: We included 602 patients with cancer-associated PE (median age 71 years; 49.5% female) of whom 285 (47.3%) were discharged from the ED. Of the 382 patients with symptomatic PE, 105 (27.5%) were discharged, compared to 180 of 220 (81.8%) patients with incidental PE (P < 0.001). Younger age, ECOG performance status 0-1, and absence of cardiovascular diseases, chronic obstructive lung disease, myocardial damage, right ventricle dysfunction, and renal and liver failure potentially increased the likelihood of discharge (Table). In symptomatic patients who were discharged, the cumulative 14-day mortality was 0% and PE-related readmission incidence was 2.9%, while in those hospitalized these incidences were 9.0% and 1.4%, respectively (Figure). In patients with incidental PE the cumulative 14-day mortality was 1.1% in discharged and 8.0% in hospitalized patients; none of the incidental PE patients were readmitted for PE.

Conclusion(s): This study shows that in cancer patients with acute PE, 27% with symptomatic and 81% with incidental PE are discharged from the ED, with low 14-day mortality and PE-related readmission incidences. The most important determinant for discharge was incidental PE, although 20% of such patients were still hospitalized.

Learning Objectives:

Recognize the importance of pulmonary embolism risk stratification for cancer patients
Describe potential indicators for direct discharge in cancer patients wih pulmonary embolism
Interpret safety of direct discharge in cancer patients with pulmonary embolism