Terry Bowers, MD, director of vascular medicine at Beaumont Hospital, Royal Oak, Michigan, and national co-chair of the Pulmonary Embolism Research Collaborative (PERC), explains the trend toward creating pulmonary embolism (PE) response teams that include cardiology.
Bowers was in Washington, D.C., the last week of April 2022 for a meeting of PE experts, the U.S. Food and Drug Administration (FDA), vendors and the National Pulmonary Embolism Response Team (PERT) Consortium. The FDA wants formal expert input on new devices developed for acute treatment of PE. The working group is also looking to design a PE registry and pool data that can be used to eventually create a national set of guidelines and best practices based on large scale clinical data.
There is a national trend where cardiology is increasingly being called in to help with PERT teams at hospitals. Today, this is the direction many centers are going to more aggressively treat PE patients with interventional catheter thrombectomy to improve outcomes and reduce mortality. There is a growing movement toward this using interdisciplinary PE care team that involve radiology, cardiology, vascular surgery, interventional radiology, emergency room physicians and pulmonology.
"More and more hospitals are coming together and saying we are partners in this," Bowers said. "In regards to interventional radiology and interventional cardiology, it's not one discipline's disease that needs to be hand selected for them only. At our institution, we have a cohesive team that spans from cardiology, radiology and emergency medicine, and we all play an integral role in in the team."
Beaumont was an early adopter of interventional thrombectomy in the late 1990s to more aggressively treat PE patients beyond what was the standard-of-care using just thrombolytics. Bowers said there is a historical mortality rate of between 8%-14% for intermediate and high-risk PE patients, but with a thrombectomy-first approach, they lowered this to 1.3% in-hospital mortality, and 1.6% discharged mortality at 30 days.
"We have a PERT interventional call now, that has a correlation to the STEMI call, and frankly we see as many pulmonary embolism escalation cases now as we do STEMI cases coming through the door," Bowers explained.
Bowers said PERC wants to collect randomized PE therapy clinical data so that guidelines can eventually be drafted for a set of standardized protocols and treatments based on specific patient characteristics. Currently, Bowers said those types of national, clinical-data driven guidelines do not exist and there is not enough randomized clinical data to make broad recommendations yet.
PE is the third-leading cause of cardiovascular death in the United States, nearly as common as heart attacks and stroke. And Beaumont Health now has the largest single center database of consecutive PE patients in the world, with about 2,900 patients evaluated and treated over the past five years.
“European leaders in the treatment of PE created an algorithm, and we modified and perfected it to create a Beaumont version of how to assess all patients coming in the door with clots in their lungs,” Bowers said. “This standard for evaluation, escalation and treatment works. It identifies patients with high-risk PE early, so we’re able to treat them appropriately. You cannot argue with the results we’re getting. So we’re trying to standardize the data collection necessary to share this treatment pattern with other centers.”
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Dave Fornell has covered healthcare for more than 17 years, with a focus in cardiology and radiology. Fornell is a 5-time winner of a Jesse H. Neal Award, the most prestigious editorial honors in the field of specialized journalism. The wins included best technical content, best use of social media and best COVID-19 coverage. Fornell was also a three-time Neal finalist for best range of work by a single author. He produces more than 100 editorial videos each year, most of them interviews with key opinion leaders in medicine. He also writes technical articles, covers key trends, conducts video hospital site visits, and is very involved with social media. E-mail: dfornell@innovatehealthcare.com