What question did this study set out to answer?

To compare the safety and efficacy of the Hestia rule versus the simplified Pulmonary Embolism Severity Index for triaging acute pulmonary embolism patients for home treatment.

June 3, 2021European Heart JournalOpen Access

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

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Why the study?

The study was conducted to compare the Hestia rule versus the simplified Pulmonary Embolism Severity Index (sPESI) for triaging patients with acute pulmonary embolism for home treatment.

Does triaging with the Hestia rule compared to sPESI maintain safety and effectiveness for home treatment in normotensive patients with acute pulmonary embolism?

Population

1975 normotensive patients with PE from 26 hospitals across 4 European countries

Comparison

Triaging with Hestia rule vs triaging with sPESI

Design

Multicentre randomized trial

Follow-up

30 days

Authors

PRPierre‐Marie RoyVascular Medicine APAndréa PenalozaVascular Medicine OHOlivier HügliUniversity Hospital of Lausanne

Discussion

Member takes

Implication

Supports home treatment selection with either rule in normotensive PE; confirms comparable safety and effectiveness in RCT.

Key Points

To compare the safety and efficacy of the Hestia rule versus the simplified Pulmonary Embolism Severity Index for triaging acute pulmonary embolism patients for home treatment.
Randomized noninferiority trial (NCT02811237) across 26 hospitals in France, Belgium, the Netherlands, and Switzerland enrolling 1,975 normotensive patients with acute pulmonary embolism.
Patients were randomized to triage by the Hestia rule or simplified PESI, qualifying for home discharge within 24 hours if the tool was negative and the physician-in-charge concurred.
The primary endpoint was a 30-day composite of recurrent venous thromboembolism, major bleeding, or all-cause death tested against a 2.5% absolute risk difference noninferiority margin.
In the per-protocol analysis, the 30-day primary composite outcome occurred in 3.82% (34/891) of Hestia patients versus 3.57% (32/896) of sPESI patients (P = 0.004 for non-inferiority).
In the intention-to-treat population, 38.4% (378/984) of the Hestia group and 36.6% (361/986) of the sPESI group were treated at home within 24 hours (P = 0.41 for superiority).
Among outpatients, 30-day adverse event rates were 1.33% (5/375) for Hestia and 1.11% (4/359) for sPESI, with no fatal or recurrent pulmonary embolisms observed in either home-treated cohort.

Structured PICO

Does triaging with the Hestia rule compared to sPESI maintain safety and effectiveness for home treatment in normotensive patients with acute pulmonary embolism?

Population

1,975 normotensive patients with acute pulmonary embolism (PE) from 26 hospitals across France, Belgium, the Netherlands, and Switzerland.

Intervention

Triaging for home treatment using the Hestia rule (designated for home treatment if the triaging tool was negative and the physician-in-charge agreed).

Comparator

Triaging for home treatment using the simplified Pulmonary Embolism Severity Index (sPESI) (designated for home treatment if the triaging tool was negative and the physician-in-charge agreed).

Outcome

30-day composite of recurrent venous thrombo-embolism, major bleeding or all-cause death.composite

The Hestia rule and sPESI are equally safe and effective for triaging normotensive acute PE patients for home treatment, allowing over a third of patients to be managed at home safely.

Cite This Study

Roy et al. (2021) studied this question.

synapsesocial.com/papers/6a81293d9fceb4fbd5e3d79f https://doi.org/10.1093/eurheartj/ehab373

Topics

Pulmonary embolism

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

Discussion

Member takes

Implication

Key Points

Structured PICO

Cite This Study

Topics

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

Discussion

Member takes

Implication

Key Points

Structured PICO

Cite This Study

Also Consider

Topics

Also Consider