HOME-PE: HESTIA Noninferior to sPESI for Triaging Following Pulmonary Embolism

New data from the HOME-PE study supports the use of HESTIA criteria as a triaging strategy for care of patients with acute pulmonary embolism.

Presented at the European Society of Cardiology (ESC) Congress 2020, results indicate use of HESTIA was non inferior to sPESI for the study’s primary end point, which was a composite of recurrent venous thromboembolism, major bleeding events, and death.

“These results support outpatient management of acute pulmonary embolism patients using either the Hestia method or the sPESI score with the option for physicians to override the decision. In hospitals organized for outpatient management, both triaging strategies enable more than a third of pulmonary embolism patients to be managed at home with a low rate of complications,” said Pierre-Marie Roy, MD, PhD, Department Head at the University Hospital of Angers, France, in a statement from the ESC.

Enrolling more than 1900 patients from 4 European countries, HOME-PE was the first prospective randomized study to compare a pair of resigning strategies for outpatient treatment of pulmonary embolism patients. Enrolled within 24 hours of a diagnosis, investigators hoped to draw a definitive conclusion on use of a pragmatic approach such as HESTIA for determining which patients could be managed with outpatient therapy at home. In total, 984 patients were randomized to a HESTIA approached and 986 were randomized to the sPESI group.

Among those in the HESTIA group, 39% were considered eligible for outpatient care, of which 3% were overruled by the physician-in-charge. Additionally, investigators found just 1% of those HESTIA determined were in need of hospitalization were eligible for outpatient. Among those in the sPESI group, 48% were considered eligible for outpatient care and 52% required further hospitalization. Of those considered eligible for outpatient care, 29% of these patients were overruled by the physician-in-charge. Additionally, 3% of the patients in need of further hospitalization according to sPESI were eligible for outpatient care. Final management rates between the 2 study arms were similar, as were the rates of adverse events in outpatients. Upon analysis, the primary outcome of the study occurred in 3.8% of the HESTIA group and 3.6% of the sPESI group (P=.005).

For more perspective, Practical Cardiology reached out to Roy to take part in discussion related to the results of HOME-PE.

This study, “Hospitalization or Outpatient Management of Patients with Pulmonary Embolism: HESTIA versus simplified PESI,” was presented at ESC Congress 2020.