期刊
JOURNAL OF THROMBOSIS AND THROMBOLYSIS
卷 48, 期 1, 页码 149-157出版社
SPRINGER
DOI: 10.1007/s11239-019-01814-z
关键词
Pulmonary embolism; Trauma Severity Index; Cost of illness; Veterans Health Administration
资金
- Janssen Scientific Affairs, LLC
IntroductionVarious risk stratification methods exist for patients with pulmonary embolism (PE). We used the simplified Pulmonary Embolism Severity Index (sPESI) as a risk-stratification method to understand the Veterans Health Administration (VHA) PE population.Materials and methodsAdult patients with 1 inpatient PE diagnosis (index date=discharge date) from October 2011-June 2015 as well as continuous enrollment for 12months pre- and 3months post-index date were included. We defined a sPESI score of 0 as low-risk (LRPE) and all others as high-risk (HRPE). Hospital-acquired complications (HACs) during the index hospitalization, 90-day follow-up PE-related outcomes, and health care utilization and costs were compared between HRPE and LRPE patients.ResultsOf 6746 PE patients, 95.4% were men, 67.7% were white, and 22.0% were African American; LRPE occurred in 28.4% and HRPE in 71.6%. Relative to HRPE patients, LRPE patients had lower Charlson Comorbidity Index scores (1.0 vs. 3.4, p<0.0001) and other baseline comorbidities, fewer HACs (11.4% vs. 20.0%, p<0.0001), less bacterial pneumonia (10.6% vs. 22.3%, p<0.0001), and shorter average inpatient lengths of stay (8.8 vs. 11.2days, p<0.0001) during the index hospitalization. During follow-up, LRPE patients had fewer PE-related outcomes of recurrent venous thromboembolism (4.4% vs. 6.0%, p=0.0077), major bleeding (1.2% vs. 1.9%, p=0.0382), and death (3.7% vs. 16.2%, p<0.0001). LRPE patients had fewer inpatient but higher outpatient visits per patient, and lower total health care costs ($12,021 vs. $16,911, p<0.0001) than HRPE patients.ConclusionsUsing the sPESI score identifies a PE cohort with a lower clinical and economic burden.
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