Patients presenting with acute pulmonary embolism in primary care settings can be safely managed without hospitalization, a study finds

Of more than 600 encounters involving pulmonary embolism diagnosis in primary care, patients were sent home in 20.6%, and in 37.8% of encounters referred to the ED, patients were discharged home without events. Only one outpatient had an adverse event within 30 days.

Thirty-day adverse events were uncommon among patients diagnosed with acute pulmonary embolism in a primary care setting, a study found.

Researchers conducted a multicenter retrospective cohort study among adults diagnosed with acute pulmonary embolism and stratified by initial site-of-care decisions in primary care in a large, diverse community-based U.S. health system from 2013 to 2019. The primary outcome was a composite of 30-day serious adverse events, defined as recurrent venous thromboembolism, major bleeding, and all-cause mortality. The secondary outcome was seven-day pulmonary embolism-related hospitalization, either initial or delayed. Results were published Jan. 12 by the Journal of General Internal Medicine.

The study included 652 patient encounters in 646 patients. In 134 encounters (20.6%), patients were sent home from primary care. In the other 518 encounters (79.4%), patients were referred to the ED. Among the referred encounters, patients were discharged home without events in 196 (37.8%). Eight patients (1.2%; 95% CI, 0.5% to 2.4%) had a 30-day serious adverse event, with four venous thromboembolisms (0.6%), one major bleeding event (0.2%), and three deaths (0.5%). Of these eight patients, seven were initially hospitalized and one had been sent home from primary care. All three of the patients who died had known metastatic cancer and were initially referred to the ED, hospitalized, and enrolled in hospice after discharge. Overall, patients were hospitalized within seven days for 328 (50.3%) of encounters, 322 at the time of the index diagnosis and six after initial outpatient management (four in the clinic and two in the clinic plus ED).

Thirty-day adverse events were uncommon regardless of initial site-of-care decisions, the authors said. Delayed seven-day pulmonary embolism-related hospitalization was rare among the 51% of encounters treated on an outpatient basis. The authors concluded that primary care management of acute pulmonary embolism appears to be safe and wrote that this finding could have implications for cost-effectiveness and for patient care experience.