Introduction: The British Lung Foundation recommends specialist review of patients with acute PE but this is not consistent UK practice, nor included in NICE guidance.
Aims and Objectives: Evaluation of the effectiveness of specialist review of all patients after 6 months? treatment for acute PE.
Methods: All patients over a 5-year period underwent retrospective review to assess diagnostic accuracy, persistence of cardio-respiratory symptoms, concluding explanatory diagnoses and requirement for specialist pulmonary hypertension service intervention.
Results: 995 patients were identified. The diagnosis of acute PE was concluded as incorrect in 33 (3.3%) patients. In 24 (2%) patients with confirmed PE, additional diagnoses requiring significant management changes were identified. 49 (5%) patients were diagnosed with chronic thromboembolic disease and 37 (4%) were referred to the National Pulmonary Hypertension Service, Cambridge: 28 (3%) had pulmonary hypertension, 15 required pulmonary endarterectomy (plus patent foramen ovale closure in 2, and coronary artery bypass grafting in 2 patients). 12 patients required PH-specific pharmacotherapy and 7 died (1 prior to assessment, 1 following endarterectomy, 2 from right ventricular failure, 1 from pontine haemorrhage and 2 from unrelated comorbidities).
Conclusions: 11% of patients had significant alterations made to their management. The incidence of chronic thromboembolic pulmonary hypertension was similar when compared to that identified in published reports from tertiary centres1,2.
References:
1.Tapson VF et al. Proc Am Thorac Soc. 2006 Sep;3(7):564-7.
2.Guérin L et al. Thromb Haemost. 2014 Sep 2;112(3):598-605.