ATS 2021 will feature presentations of original research from accepted abstracts. Mini Symposia and Thematic Poster Sessions are abstract based sessions.
Please use the form below to browse scientific abstracts and case reports accepted for ATS 2021. Abstracts presented at the ATS 2021 will be published in the Online Abstract Issue of the American Journal of Respiratory and Critical Care Medicine, Volume 203, May 3, 2021.
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Early Lessons from a Post-Pulmonary Embolism Follow Up Clinic
Session Title
TP88 - TP088 LUCY IN THE SKY WITH DIAMONDS - PULMONARY EMBOLISM, CTEPH, THROMBOSIS, AND COVID19: CLINICAL ADVANCES
Abstract
A3715 - Early Lessons from a Post-Pulmonary Embolism Follow Up Clinic
Author Block: J. Noto1, P. Rali2; 1Internal Medicine, Temple University Hospital, Philadelphia, PA, United States, 2Pulmonary and Critical Care Medicine, Temple University, Philadelphia, PA, United States.
Rationale Pulmonary embolism response teams (PERT) are becoming the standard of care for acute pulmonary embolism (PE) management. The potential complications of acute PE extend far beyond the initial hospitalization period. Few studies have examined the utility and potential benefits of a dedicated post-PE follow up clinic. At our center, every patient evaluated by the PERT team is given an appointment in outpatient pulmonary clinic. The purpose of this study is to share our early experience with a dedicated post-PE follow up clinic.
Methods A retrospective review of all PE patients who were seen in PE clinic from August 2017 to November 2020 was performed. Primary study outcomes included baseline demographics, PE classification, time from discharge to initial appointment, and clinic retention rate. Secondary study outcomes included anticoagulation (AC) management at 6 months follow up, IVC filter removal rate, perioperative AC management, targeted diagnostic testing, new pulmonary diagnoses and medications, incidence of residual pulmonary vascular obstruction (RPVO) and chronic thromboembolic pulmonary hypertension (CTEPH).
Results A total of 450 patients were evaluated by the inpatient PERT team from August 2017 to November 2020, with 90 patients following up in PE clinic. Median time from hospital discharge to first appointment was 27 days (IQR 5 - 44 days). Retention rate, defined by attendance at ≥ 2 appointments was 75.6%. Duration of AC was addressed in 77.8% of patients. AC dosing was transitioned to prophylaxis in 24.4% and discontinued in 3.3% of patients at six months. IVC filter removal rate was 100% for the three patients who had a filter placed. Perioperative AC management for patients undergoing surgery after PE was addressed in 8.9% of cases. Targeted testing (ventilation perfusion (VQ) scan, echocardiogram, pulmonary function testing, sleep study, venous duplex, CT chest, right heart catheterization) revealed undiagnosed pulmonary disease in 21.1% patients. Of the 54 patients who underwent a VQ scan, 65.4% were found to have RPVO. CTEPH was diagnosed in 2.2% of patients. Pulmonary medications were started or adjusted in 22.2% of patients.
Conclusion Our data illustrate the value of a dedicated outpatient PE follow up clinic. Our PE clinic offered patients place to discuss AC duration and dosing, IVC filter removal, perioperative AC, and workup of post-PE complications such as RPVO and CTEPH. Patients also received treatment and diagnosis of pre-existing pulmonary conditions. The management of outpatient PE is challenging and a dedicated PE clinic may improve patient care.
Author Block: J. Noto1, P. Rali2; 1Internal Medicine, Temple University Hospital, Philadelphia, PA, United States, 2Pulmonary and Critical Care Medicine, Temple University, Philadelphia, PA, United States.
Rationale Pulmonary embolism response teams (PERT) are becoming the standard of care for acute pulmonary embolism (PE) management. The potential complications of acute PE extend far beyond the initial hospitalization period. Few studies have examined the utility and potential benefits of a dedicated post-PE follow up clinic. At our center, every patient evaluated by the PERT team is given an appointment in outpatient pulmonary clinic. The purpose of this study is to share our early experience with a dedicated post-PE follow up clinic.
Methods A retrospective review of all PE patients who were seen in PE clinic from August 2017 to November 2020 was performed. Primary study outcomes included baseline demographics, PE classification, time from discharge to initial appointment, and clinic retention rate. Secondary study outcomes included anticoagulation (AC) management at 6 months follow up, IVC filter removal rate, perioperative AC management, targeted diagnostic testing, new pulmonary diagnoses and medications, incidence of residual pulmonary vascular obstruction (RPVO) and chronic thromboembolic pulmonary hypertension (CTEPH).
Results A total of 450 patients were evaluated by the inpatient PERT team from August 2017 to November 2020, with 90 patients following up in PE clinic. Median time from hospital discharge to first appointment was 27 days (IQR 5 - 44 days). Retention rate, defined by attendance at ≥ 2 appointments was 75.6%. Duration of AC was addressed in 77.8% of patients. AC dosing was transitioned to prophylaxis in 24.4% and discontinued in 3.3% of patients at six months. IVC filter removal rate was 100% for the three patients who had a filter placed. Perioperative AC management for patients undergoing surgery after PE was addressed in 8.9% of cases. Targeted testing (ventilation perfusion (VQ) scan, echocardiogram, pulmonary function testing, sleep study, venous duplex, CT chest, right heart catheterization) revealed undiagnosed pulmonary disease in 21.1% patients. Of the 54 patients who underwent a VQ scan, 65.4% were found to have RPVO. CTEPH was diagnosed in 2.2% of patients. Pulmonary medications were started or adjusted in 22.2% of patients.
Conclusion Our data illustrate the value of a dedicated outpatient PE follow up clinic. Our PE clinic offered patients place to discuss AC duration and dosing, IVC filter removal, perioperative AC, and workup of post-PE complications such as RPVO and CTEPH. Patients also received treatment and diagnosis of pre-existing pulmonary conditions. The management of outpatient PE is challenging and a dedicated PE clinic may improve patient care.
