First ACC/AHA acute pulmonary embolism guidelines include new categories for risk stratification
The American College of Cardiology (ACC) and American Heart Association (AHA) have developed their first clinical practice guidelines focused on the treatment and management of acute pulmonary embolism (PE). The new document, published in full in JACC and Circulation, highlights the importance of diagnosing patients as quickly as possible and determining the best course of action.
A PE is a potentially fatal blood clot that travels through the heart and then becomes lodged in an artery in the lungs. Treating PEs quickly—and effectively—can help minimize the patient’s risk of death and cardiac arrest. Anticoagulants are the most common PE treatment, but catheter-based interventions and surgery may be necessary for more severe cases.
“There have been significant advances in the understanding of PE and treatments to effectively manage this condition,” Mark A. Creager, MD, chair of the document’s writing committee and director emeritus of the Heart and Vascular Center at Dartmouth Health, said in a statement. “This guideline is a road map to help clinicians navigate these advances for the safest and most effective approaches to care for people with this condition.”
New clinical categories for classifying PE patients
One of the primary takeaways from this new guidance is the creation of five new clinical categories that can be used to define the severity of a PE and help care teams develop a safe, effective treatment strategy. Category A would be used to describe a PE associated with lowest possible risk. Category E, meanwhile, would be used to describe the most high-risk, severe PE cases.
Category A: Asymptomatic PE cases. The patient does not need to be hospitalized.
Category B: Symptomatic PE cases with a low clinical severity score. The patient can typically be discharged from the hospital early after undergoing a full examination.
Category C: Symptomatic PE cases with an elevated clinical severity score. Right ventricular dysfunction and various biomarkers may be elevated. The patient should be hospitalized to ensure optimal care is provided.
Category D: There are early signs of cardiopulmonary failure, potentially characterized by transient hypotension. The patient should be hospitalized to ensure optimal care is provided.
Category E. Complete cardiopulmonary failure, including recurrent or persistent hypotension. The patient may experience cardiogenic shock or cardiac arrest. The patient should be hospitalized to ensure optimal care is provided.
PE response teams can make a difference
The document also highlights the continued importance of multidisciplinary PE response teams (PERTs) that may include cardiologists as well as representatives from the fields of cardiac surgery, vascular medicine, pharmacy, nursing and emergency medicine. Patients and/or their loved ones could also be included in a PERT.
Many medical societies worked together to bring PE document to life
In addition to the ACC and AHA, eight additional medical societies collaborated on these guidelines and officially endorsed them: the American College of Clinical Pharmacy, American College of Emergency Physicians, American College of Chest Physicians, Society for Cardiovascular Angiography & Interventions, Society of Hospital Medicine, Society of Interventional Radiology, Society for Vascular Medicine and Society of Vascular Nursing.
Michael has more than 19 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.