Multidisciplinary pulmonary embolism response team in China: A nationwide survey

Acute pulmonary embolism (PE) is a silent killer and the third most common cause of death from cardiovascular disease,1 although it incurs a much lower public awareness. The Pulmonary Embolism Response Team (PERT) model was developed in the USA to rapidly engage multidisciplinary specialists to generate shared decision-making recommendations for high-risk PE.2 This approach has expanded globally including China, where the China Consortium of PERT was established in 2017.3 We conducted the first nationwide survey based on members of the China Consortium of PERT and the Pulmonary Vascular Disease Group of Chinese Society of Cardiology (CSC) to delineate the current status of PERT practice in China. We recruited hospitals in seven geographical regions: Northern, Northeast, Eastern, Central, Southern, Southwest and Northwest China, which were subdivided into low, medium-low, medium-high and high economic levels. In each geographic-economic region, one to three tertiary hospitals were recruited. Using a modified Delphi method, the survey was created by two authors (X.W. and S.N.), circulated by email to key panel members and pilot-tested by five participants. All responses were collected between 11 and 20 September 2019. Of the 49 participants surveyed, 45 participants of 45 hospitals responded (response rate, 91.8%). The Ethics Committee of Beijing Anzhen Hospital, Capital Medical University, approved this study. All participants provided written informed consent. Twelve participants (27%) self-reported to have a fully functional PERT programme, while 16 (35%) were partially functional, 6 (11%) were still in development and 12 (27%) had no PERT. Most programmes (88%) involved five or more specialties. The specialties most commonly involved in PERT were general cardiology (96%), emergency medicine (82%) and pulmonary/critical care (82%). Only 54% of interventional cardiology and 39% of cardiac surgery were actively involved in the programmes (Fig. 1). In fully or partially functional PERT, most activations were initiated by doctors in the general cardiology (22/28, 79%) or emergency medicine (20/28, 71%). Most participants used telephone alerts (96%) or Wechat software (37%) to activate a PERT, while only one participant used dedicated PERT device. The indications for PERT activations were high-risk (89%) or intermediate-high risk PE (89%). Systemic thrombolysis (26/28, 93%) and inferior vena cava (IVC) filter placement (27/28, 96%) were available in almost all hospitals with PERT. Most PERT programmes offered the ability of catheter-based therapy (23/28, 82%), surgical embolectomy (17/28, 61%) and extracorporeal membrane oxygenation (24/28, 86%). The present survey provided a window into comparisons of PERT model among countries. Our survey showed that only one-fourth of hospitals had a fully functional PERT programme. A large majority of PERT were partially operational or developing, representing the spread of this new multidisciplinary approach for PE care across China. Although most of the advanced therapies including catheter-based therapies and surgical embolectomy were available among the responding PERT centres, only about half of interventional cardiology and two-fifth of cardiac surgery were actively involved in the PERT programmes, which were lower than the frequencies in the USA.4 The implementation of PERT approach has changed the treatment model and increased the use of advanced therapy in Western Countries.2 Studies pertaining to the impact of PERT approach on PE care and outcomes in China are urgently needed. The authors thank members of the China Consortium of PERT and the Pulmonary Vascular Disease Group of CSC for completing the survey. This work was funded by grants from Beijing Municipal Administration of Hospitals Clinical Medicine Development of Special Funding Support (ZYLX201710), Beijing Municipal Administration of Hospitals' Ascent Plan (DFL20180601), Beijing Lab for Cardiovascular Precision Medicine, Beijing, China (PXM2018_014226_000013) and Beijing Nova Program (Z201100006820087). K.R.: research funding (funds to Massachusetts General) from Boston Scientific and National Institutes of Health; scientific advisory board/consulting for Angiodynamics, Boston Scientific, Janssen, Magneto, Philips, Surmodics and Thrombolex; equity in Access Vascular, Contego and Thrombolex; and board member for National PERT Consortium and VIVA Physicians (501c3 non-profit organizations). V.T.: research funding (funds to Cedars-Sinai) from Bayer, Bristol Myers Squibb, Janssen, EKOS/BTG, Inari and Penumbra; advisory boards for Bristol Myers Squibb and Janssen; and board member for National PERT Consortium (a 501c3 non-profit organization). Conceptualization: X.W., S.N. Data curation: X.W., Q.J., S.N. Funding acquisition: S.N. Formal analysis: X.W., Q.J. Investigation: K.R., V.T., S.N. Project administration: S.N. Methodology: X.W., Q.J., V.T. Resources: X.W. Supervision: K.R., V.T., S.N. Writing—original draft: X.W. Writing—review and editing: Q.J., K.R., V.T., S.N.