Audit on risk stratification and follow-up of pulmonary embolism as per 2019 ESC guidelines

Abstract

BACKGROUND: Pulmonary embolism is a common and potentially life-threatening disease. The aim of this audit is to determine whether the necessary investigations for risk stratification were taken, including troponin and N-terminal pro B-type natriuretic peptide to assess for heart strain and whether appropriate follow-up was provided with echocardiography and outpatients appointment as per 2019 ESC guidelines on pulmonary embolism.

METHOD: Retrospective review of computed tomography pulmonary angiographies (CTPA) performed from 1st July 2022 to 31st December 2022 at Mater Dei Hospital and Gozo General Hospital. Documentation on investigations carried out and appropriate follow-up were collected from Picture Archiving and Communication System (PACS) and iSOFT Clinical Manager.

RESULTS: A total of 1682 CTPAs were carried out over the investigated period, out of which 12.8% (n=216) had a PE. Only 34.7% had troponin levels checked and 25.5% had NT-pro-BNP levels checked. Right heart strain was reported on CTPA in 13.9% of patients with a PE. In these patients, testing of cardiac biomarkers was higher with 70.0% of them having at least one cardiac biomarker tested. 30.1% of patients with PE had an echocardiogram done, most of which (73.8%) were as outpatients. More patients (56.7%) had an echo done when right heart strain was documented. Only 42.6% of patients had appropriate outpatients follow-up within 6 months of discharge.

CONCLUSION: A structured management plan in the form of local guidelines is necessary which will aid the emergency physician and also the internal medical clinician to treat and follow-up appropriately.