Multidisciplinary PERS Team Approach Shows Improved Pulmonary Embolism Outcomes

May 5, 2015—The Society for Cardiovascular Angiography and Interventions (SCAI) announced that a study, “Outcome of Implementation of a Multidisciplinary Pulmonary Embolism Response Service (PERS),” will be presented as an ePoster at the SCAI 2015 Scientific Sessions being held May 6–9 in San Diego, California. The study demonstrates that when specialists confer and agree on treatment of patients with high-risk pulmonary embolism (PE), patients are treated more aggressively and have better outcomes.
 
The society advised that the Peripheral educational track at the conference will feature “Pulmonary Embolism: The Untapped Frontier for the Cardiologist,” moderated by SCAI 2015 Program Committee Chair Michael R. Jaff, DO, and Geno Merli, MD. 

In the SCAI press release, Neal Bhatia, MD, of Emory University School of Medicine described the PERS organization used at Emory University Hospital Midtown in Atlanta, Georgia, and the outcomes of patients treated by the PERS. Dr. Bhatia commented, “Treating patients with PE is complicated. Part of the complexity in the management of PE is due to the wide spectrum of clinical presentations. Physicians must decide among multiple treatment options but lack a standard approach and clear guidelines for higher-risk patients.” 

At Emory, a PERS—composed of cardiologists, pulmonologists, radiologists, and cardiothoracic surgeons—was established to improve outcomes among the high-risk PE patient population. The 24-hour service responds to calls from clinicians, mostly emergency physicians and hospitalists, about patients presenting with PE. The PERS team reviews each case and discusses treatment options for patients considered to be at high risk for morbidity or mortality before reaching a consensus. The team also developed treatment algorithms, including systemic thrombolysis, catheter-directed thrombolysis, surgery, and inferior vena cava filters. 

The study is a prospective registry of 143 patients treated by the Emory PERS team between December 2012 and July 2014. Outcomes of the patients were tracked for 6 months. The PERS team treated higher-risk patients who were on the borderline of decompensating or whose condition was deteriorating with more aggressive treatment—either catheter-directed or systemic thrombolytics. In the SCAI press release, Dr. Bhatia noted, “Most of these patients may not have been treated as aggressively as we did because the guidelines are unclear and controversial.” 

Dr. Bhatia reviewed outcomes at 6 months and found that the patients who received the more aggressive therapies were less likely to have died or experienced recurrent PE than those treated with the standard treatment. Patients who received aggressive treatments had improved in-hospital mortality (8% vs 15%), recurrent PE (4% vs 10%), and 6-month mortality (12% vs 28%). 

“This analysis demonstrates the validity of collaborating with multiple specialties to improve diagnosis and outcomes for patients with PE. Such a team approach could change the odds for patients afflicted with this deadly condition,” concluded Dr. Bhatia in the SCAI announcement.