Similar outcomes sPESI and HESTIA for pulmonary embolism triage

The HOME-PE trial suggests that the simplified Pulmonary Embolism Severity Index (sPESI) score, recommended by European guidelines, and the HESTIA criteria, recommended by U.S. guidelines, performed equally well in selecting which haemodynamically stable patients with acute pulmonary embolism are eligible for home management [1].

Selected haemodynamically stable patients with acute pulmonary embolism could be treated at home. However, controversy persists about the optimal referral strategies and eligibility criteria for outpatient care. European guidelines recommend the PESI or sPESI score to assess the risk of all-cause mortality. If proper follow-up and anticoagulant therapy can be provided, patients with an sPESI score of 0 can be treated at home. The American guidelines do not require a predefined score and advise using pragmatic criteria, for example those formulated in the HESTIA Study.

Prof. Pierre-Marie Roy (University Hospital of Angers, France) presented the randomised, open-label, non-inferiority HOME-PE trial. The 1,974 normotensive participants, who presented to the emergency department with acute pulmonary embolism, were randomised to either the pragmatic HESTIA method or sPESI triage group:

• 
  
  • 
    
    • in the sPESI group, patients were eligible for outpatient care if the score was 0 (n=986); and
    • in the HESTIA group, they were eligible for outpatient care if all 11 criteria were negative (n=984).

Patients who were not eligible for outpatient care were hospitalised. In both groups, the treating physician could overrule the decision on treatment location for medical or social reasons.

The primary endpoint, a composite of recurrent venous thromboembolism (VTE), major bleeding, and all-cause mortality within 30 days, occurred in 3.8% of patients in the HESTIA group and 3.6% in the sPESI group (P=0.005 for non-inferiority). Of note, a greater proportion of patients were eligible for home care using sPESI compared with HESTIA (48.4 vs 39.4%). However, the treating physician overruled sPESI more often than HESTIA. Consequently, a similar proportion of patients were discharged within 24 hours for home treatment (38.4 and 36.6%, respectively; P=0.42). In patients managed at home, the rate of complications was low.

The HOME-PE study showed that the HESTIA approach was non-inferior to the sPESI score as triaging strategy for outpatient care of patients with acute pulmonary embolism. Prof. Roy concluded, “These results support outpatient management of acute pulmonary embolism patients using either the HESTIA method or the sPESI score. In hospitals organised for outpatient management, both triaging strategies enable more than a third of pulmonary embolism patients to be managed at home with a low rate of complications.”

 

1. 
   
   1. Roy P-M. HOME-PE - Hospitalisation or Outpatient Management of PE Patients - HESTIA vs. Simplified PESI. Hot Line 3 session, ESC 2020 E-Congress, 31 Aug.

 



Posted on 5 November 202020 February 2024