Physicians' Academy for Cardiovascular Education

Two triage strategies for outpatient management of PE patients were similar for clinical outcomes

News - Aug. 31, 2020

Hospitalization or Outpatient Management of Patients with Pulmonary Embolism: HESTIA versus simplified PESI

Presented at the ESC congress 2020 by Pierre-Marie Roy (Angers, France)

Introduction and methods

Several studies have demonstrated the possibility of home treatment for low risk pulmonary embolism (PE) patients, if proper outpatient care and anticoagulant therapy can be provided. However, controversy persists on triage strategy on eligibility criteria for outpatient management. The ESC recommends to use an all-cause mortality risk assessment, using the simplified PESI score, but ACC does not recommend a predefined scoring system and suggests to use a list of pragmatic criteria, such as the HESTIA rule.

Therefore, two triage strategies for outpatient treatment of PE patients were compared in a controlled randomized trial, the HOME-PE study, with blind adjudication of end points. 1974 Patients were enrolled in the emergency department within 24 hours following diagnosis. Patients were randomized to triage based on the HESTIA rule (containing 11 criteria, with 0 criteria the patient is negative and eligible to go home) or the sPESI rule (containing 6 criteria, with sPESI=0 patient is eligible to go home). Non-inferiority was tested for strategy based on the HESTIA rule vs. strategy based on sPESI. Outcome was a composite of recurrent VTE, major bleeding or death after 30 days.

*IMain results*I


The HOME-PE study demonstrated that triage strategy based on the pragmatic rule, HESTIA, was non-inferior to the strategy based on the severity risk assessment score, sPESI, with regard to a composite end point of recurrent venous thromboembolism, major bleeding and death in patients with acute PE. The authors conclude that outpatients care can be safely performed for patients with acute PE, using either the HESTIA rule or the sPESI score with overruling by the physician-in-charge.

- Our reporting is based on the information provided at the ESC congress -

Watch a video by prof. Huisman on the HOME-PE trial

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