Multidisciplinary response team may improve care in PE
HOLLYWOOD, Fla. — Patients may benefit from a multidisciplinary response team designed to address pulmonary embolism, a speaker said at the International Symposium on Endovascular Therapy.
“PE is the third leading cause of CV death in the United States behind stroke and MI, and yet there’s a huge treatment gap, with less than 5% of these patients actually receiving advanced therapies,” Kenneth Rosenfield, MD, MHCDS, Cardiology Today’s Intervention Editorial Board member and section head of vascular medicine and intervention at Massachusetts General Hospital, said during a presentation.
Several barriers exist to treating patients with PE, Rosenfield noted, including failure to recognize PE and failure to recognize the potential benefit of treatment. Moreover, there are a number of therapeutic alternatives for acute PE, such as anticoagulation, thrombolysis, mechanical thrombectomies and more, but a lack of hard evidence on optimal treatment strategies. Guidelines are also not particularly helpful, as they recommend that physicians employ clinical judgment in decision-making. Combined, these issues lead to inconsistency in treatment, he said.
To address this problem at Massachusetts General Hospital, Rosenfield and colleagues developed a PE response team, or PERT. The goal is to improve patient outcomes through use of a collaborative, multidisciplinary team-based urgent consult to treat massive and submassive PE. When a patient presents with submassive or massive PE, the team, which includes ED physicians, nurses, cardiologists, interventional radiologists, as well as clinicians from other specialties, initiates an electronic meeting during which they discuss the case and come to a consensus about how to treat the patient.
Based on a rapid response concept, PERT is designed to respond expeditiously; provide the best therapeutic option with the input of a multidisciplinary team of experts to coordinate care; develop protocols for best practices; collect data to fill the unmet clinical need; and provide a better evidence base to close the current knowledge gap regarding PE treatment, Rosenfield said.
He noted that the collaborative and multidisciplinary nature of PERT has improved communication and transition of care for patients. Additionally, he and colleagues have increased awareness and education at their institution, which has led to more consistency in management and better follow-up.
Although demonstrating the benefits of PERT through clinical research is challenging due to the difficulty in randomly assigning these patients, there are opportunities for collaboration across institutions with PERTs, large-scale data collection and other initiatives.
“PE is still very poorly understood,” Rosenfield said. “We have a heightened awareness about the need for this institutional coordinated approach, and we believe this team approach provides optimal care.” – by Melissa Foster
Rosenfield K. Focused Symposium I: Venous intervention. Presented at: International Symposium on Endovascular Therapy; Feb. 4-8, 2017; Hollywood, Fla.
Disclosure: Rosenfield reports financial ties with Abbott Vascular, Access Vascular, Atrium, Capture Vascular, Cardinal Health, CardioMEMS, Contego, Cruzar Systems, Embolitech, Endospan, Eximo, Icon, Inari Medical, Inspire MD, Janacare, Lutonix-Bard, MD Insider, Micell, Primacea, PQ Bypass, Proteon, Shockwave, Silk Road Medical, SurModics, Valcare, Volcano/Philips and Vortex.