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Article Dans Une Revue European Heart Journal Année : 2021

Triaging acute pulmonary embolism for home treatment by Hestia or simplified PESI criteria: the HOME-PE randomized trial

1 CHU Angers - Centre Hospitalier Universitaire d'Angers
2 MITOVASC - MitoVasc - Physiopathologie Cardiovasculaire et Mitochondriale
3 ICAT - SFR UA 4208 Interactions Cellulaires et Applications Thérapeutiques
4 F-Crin Innovte [CHU Saint-Etienne]
5 F-CRIN, Innovative clinical research network in vaccinology (I-REIVAC)
6 UCL - Université Catholique de Louvain = Catholic University of Louvain
7 Cliniques Universitaires Saint-Luc [Bruxelles]
8 CHUV - Centre Hospitalier Universitaire Vaudois = Lausanne University Hospital [Lausanne]
9 LUMC - Leiden University Medical Center
10 CIC 1418 - CIC - HEGP
11 Service d’Épidémiologie et de Recherche Clinique [CHU HEGP]
12 Centre Hospitalier Intercommunal Toulon-La Seyne sur Mer - Hôpital Sainte-Musse
13 CHRU Brest - Centre Hospitalier Régional Universitaire de Brest
14 GETBO - Groupe d'Etude de la Thrombose de Bretagne Occidentale
15 CIC Brest
16 Services des Urgences [CHU Rouen]
17 NU - Normandie Université
18 CHU Sart Tilman - Centre Hospitalier Universitaire Sart Tilman
19 Rode Kruis Hospital Beverwijk
20 IThEM - U1140 - Innovations thérapeutiques en hémostase = Innovative Therapies in Haemostasis
21 HEGP - Hôpital Européen Georges Pompidou [APHP]
22 AP-HP - Hôpital Cochin Broca Hôtel Dieu [Paris]
23 HP2 - Hypoxie et PhysioPathologie
24 CHUGA - Centre Hospitalier Universitaire [CHU Grenoble]
25 Pôle Urgences [CHU Clermont-Ferrand]
26 UCA - Université Clermont Auvergne
27 CHU Toulouse - Centre Hospitalier Universitaire de Toulouse
28 Hôpital Louis Mourier - AP-HP [Colombes]
29 Hôpital Saint-Pierre, Bruxelles
30 CHU Montpellier
31 EA 2992 - Caractéristiques féminines des dysfonctions des interfaces cardio-vasculaires
32 CIC Montpellier
33 CHU Dijon
34 Centre Hospitalier Le Mans (CH Le Mans)
35 Hôpital Charles Nicolle [Rouen]
36 EnVI - Endothélium, valvulopathies et insuffisance cardiaque
37 Hôpital Cochin [AP-HP]
38 TIMC - Translational Innovation in Medicine and Complexity / Recherche Translationnelle et Innovation en Médecine et Complexité - UMR 5525
39 TIMC-ThEMAS - Techniques pour l'Evaluation et la Modélisation des Actions de la Santé
40 CHU Clermont-Ferrand
41 CHU - Hôpital Lapeyronie [Montpellier]
42 UM - Université de Montpellier
43 UAH - Universidad de Alcalá - University of Alcalá
Frederikus Klok
Frits Mulder
  • Fonction : Auteur
Magali Bartiaux
Nicolas Falvo
  • Fonction : Auteur
Stephan Hendriks

Résumé

Abstract Aims The aim of this study is to compare the Hestia rule vs. the simplified Pulmonary Embolism Severity Index (sPESI) for triaging patients with acute pulmonary embolism (PE) for home treatment. Methods and results Normotensive patients with PE of 26 hospitals from France, Belgium, the Netherlands, and Switzerland were randomized to either triaging with Hestia or sPESI. They were designated for home treatment if the triaging tool was negative and if the physician-in-charge, taking into account the patient’s opinion, did not consider that hospitalization was required. The main outcomes were the 30-day composite of recurrent venous thrombo-embolism, major bleeding or all-cause death (non-inferiority analysis with 2.5% absolute risk difference as margin), and the rate of patients discharged home within 24 h after randomization (NCT02811237). From January 2017 through July 2019, 1975 patients were included. In the per-protocol population, the primary outcome occurred in 3.82% (34/891) in the Hestia arm and 3.57% (32/896) in the sPESI arm (P = 0.004 for non-inferiority). In the intention-to-treat population, 38.4% of the Hestia patients (378/984) were treated at home vs. 36.6% (361/986) of the sPESI patients (P = 0.41 for superiority), with a 30-day composite outcome rate of 1.33% (5/375) and 1.11% (4/359), respectively. No recurrent or fatal PE occurred in either home treatment arm. Conclusions For triaging PE patients, the strategy based on the Hestia rule and the strategy based on sPESI had similar safety and effectiveness. With either tool complemented by the overruling of the physician-in-charge, more than a third of patients were treated at home with a low incidence of complications.

Dates et versions

hal-03885526 , version 1 (05-12-2022)

Identifiants

Citer

Pierre-Marie Roy, Andrea Penaloza, Olivier Hugli, Frederikus Klok, Armelle Arnoux, et al.. Triaging acute pulmonary embolism for home treatment by Hestia or simplified PESI criteria: the HOME-PE randomized trial. European Heart Journal, 2021, 42 (33), pp.3146-3157. ⟨10.1093/eurheartj/ehab373⟩. ⟨hal-03885526⟩
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