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Research Letter
June 2015

Outcomes in Adults With Acute Pulmonary Embolism Who Are Discharged From Emergency Departments: The Cardiovascular Research Network Venous Thromboembolism Study

Author Affiliations
  • 1Division of Hospital Medicine, University of California, San Francisco
  • 2Division of Research, Kaiser Permanente Northern California, Oakland
  • 3Department of Pharmacotherapy, University of Utah College of Pharmacy, Salt Lake City
  • 4Office for Health Services, Marshfield Clinic Research Foundation, Marshfield, Wisconsin
  • 5Geisinger Health System, Danville, Pennsylvania
JAMA Intern Med. 2015;175(6):1060-1062. doi:10.1001/jamainternmed.2015.0936

Patients with acute pulmonary embolism (PE) have conventionally been hospitalized for their initial management and initiation of anticoagulant treatment.1 A clinical trial2 found that patients with PE who were considered at low risk by the PE Severity Index could be safely treated as outpatients.3 However, it is unclear how often outpatient PE treatment occurs in real-world settings or whether outcomes are as favorable as in the clinical trial. Our study describes the short-term rates of death and hospital admission for patients with acute PE who were discharged from emergency department (ED) settings.

We obtained data from the Cardiovascular Research Network Venous Thromboembolism (CVRN VTE) study, a collaboration of 4 integrated health care delivery systems (Kaiser Permanente Northern California, Kaiser Permanente Colorado, Marshfield Clinic Research Foundation, and Geisinger Health System) and identified all adults (aged ≥21 years) with a primary International Classification of Diseases, Ninth Revision (ICD-9) diagnosis of pulmonary embolism (ICD-9 code 415.1x) during an ED visit from January 1, 2004, through December 31, 2010. We restricted the analysis to patients who were discharged from EDs with an anticoagulant prescription within 7 days. Exclusion criteria were less than 12 months of continuous pharmacy benefits, prior venous thromboembolism diagnoses, or outpatient anticoagulant prescriptions within 4 years. Anticoagulants included warfarin sodium, low-molecular-weight heparins, and fondaparinux sodium (because target-specific oral anticoagulants were not yet approved for use in PE). Data regarding patient demographics, medication use, and ICD-9 diagnoses were obtained from electronic databases. Primary outcomes for this analysis included hospital admission within 30 days and death within 90 days of the index ED encounter. We used descriptive statistics to report outcome rates. This study was approved by institutional review boards of the participating sites (Kaiser Permanente Northern California, Kaiser Permanente Colorado, Marshfield Clinic Research Foundation, and Geisinger Health System) and a waiver of informed consent was obtained owing to the nature of the study.