Pulmonary vascular disease & thromboembolism
Effect of a Pulmonary Embolism Diagnostic Strategy on Clinical Outcomes in Patients Hospitalized for Chronic Obstructive Pulmonary Disease (COPD) Exacerbation: A Randomized Clinical Trial
Authors' conclusion
Among patients hospitalized for an exacerbation of COPD, the addition of an active strategy for the diagnosis of PE to usual care, compared with usual care alone, did not significantly improve a composite health outcome.
Study context
- Population
- Patients hospitalized for COPD exacerbation737 (98.8%) completed
- Participants
- 746 patients
- Comparison
- Usual care plus active pulmonary embolism (PE) diagnostic strategy vs usual care
- Interventionn = 370
- Usual caren = 367reference
- Primary endpoint
- Composite of:
- Nonfatal symptomatic VTE
- Readmission for COPD
- Death
- Follow-up
- 90 days after randomization
Methodological detailsmulticentre (18 hospitals in Spain)
- Multicentre (18 hospitals in Spain)
Primary result
As reported in the abstract
Each group vs usual careAbsolute risk difference (95% CI)
Intervention
0.5%(−6.2% to 7.3%)
Each group vs usual careRelative risk (95% CI)P value
Intervention
1.02(0.82–1.28)
P = 0.86Secondary outcomes
| Outcome | Intervention | Usual care | Risk difference (95% CI) | |
|---|---|---|---|---|
| Readmission for COPD exacerbation · day 90 | 25.4% | 22.9% | 2.5% (−3.9% to 8.9%) | |
| All-cause death · 90 days | 6.2% | 7.9% | −1.7% (−5.7% to 2.3%) | |
| −10−50510Difference (linear scale) |
Nonfatal new or recurrent venous thromboembolism (VTE) · 90 days
- Not significantly different in the 2 groups (0.5% vs 2.5%)
- risk difference, −2.0% (95% CI, −4.3% to 0.1%)
Safety
| Outcome | Intervention | Usual care | Risk difference (95% CI) | P value | |
|---|---|---|---|---|---|
| Major bleeding | 0.8% | 0.8% | 0% (−1.9% to 1.8%) | P = 0.99 | |
| −2−1012Difference (linear scale) |
Original publication
Effect of a Pulmonary Embolism Diagnostic Strategy on Clinical Outcomes in Patients Hospitalized for COPD Exacerbation: A Randomized Clinical Trial. JAMA. Published 5 October 2021. doi:10.
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