对于通过经过验证的分诊工具（例如简化的 PE 严重程度指数评分或 Hestia 规则）选择的急性肺栓塞 (PE) 患者，家庭治疗被认为是安全的，但在代表性不足的亚组中的适用性存在不确定性。目的是通过进行个体患者水平的数据荟萃分析来评估家庭治疗的安全性。系统检索中确定了 10 项前瞻性队列研究或随机对照试验，总计 2694 名在家接受治疗的 PE 患者（24 小时内出院）并由预定义的分类工具进行识别。评估了 14 天和 30 天全因死亡率和不良事件（复发性静脉血栓栓塞、大出血和/或全因死亡率的综合终点）的发生率。使用随机效应模型计算亚组中 14 天和 30 天死亡率和不良事件的相对风险 (RR)。14 天和 30 天死亡率为 0.11% [95% 置信区间 (CI) 0.0-0.24， I2 = 0) 和 0.30% (95% CI 0.09-0.51，I2 = 0)。 14天和30天不良事件发生率分别为0.56%（95% CI 0.28-0.84，I2 = 0）和1.2%（95% CI 0.79-1.6，I2 = 0）。癌症与 30 天死亡率增加相关[RR 4.9；RR 4.9]。 95%预测区间（PI）2.7-9.1； I2 = 0]。就诊时已有心肺疾病、肌钙蛋白异常和异常（N 末端前）B 型利钠肽 [(NT-pro)BNP] 与 14 天不良事件发生率增加相关 [RR 3.5 (95)分别为 % PI 1.5-7.9，I2 = 0)、2.5 (95% PI 1.3-4.9，I2 = 0) 和 3.9 (95% PI 1.6-9.8，I2 = 0)]，但不是死亡率。 30 天时，癌症、肌钙蛋白异常和 (NT-pro)BNP 异常与不良事件发生率增加相关 [RR 2.7 (95% PI 1.4-5.2，I2 = 0)、2.9 (95% PI 1.5-5.7) ，I2 = 0）和 3.3（95% PI 1.6-7.1，I2 = 0），分别]。通过经过验证的分类工具选择的家庭治疗 PE 患者的不良事件发生率非常低。癌症患者的不良事件和死亡发生率高出三到五倍。肌钙蛋白或 (NT-pro)BNP 升高的患者因反复静脉血栓栓塞和出血而发生不良事件的风险增加三倍。© 作者 2024。由牛津大学出版社代表欧洲学会出版心脏病学。

Home treatment is considered safe in acute pulmonary embolism (PE) patients selected by a validated triage tool (e.g. simplified PE severity index score or Hestia rule), but there is uncertainty regarding the applicability in underrepresented subgroups. The aim was to evaluate the safety of home treatment by performing an individual patient-level data meta-analysis.Ten prospective cohort studies or randomized controlled trials were identified in a systematic search, totalling 2694 PE patients treated at home (discharged within 24 h) and identified by a predefined triage tool. The 14- and 30-day incidences of all-cause mortality and adverse events (combined endpoint of recurrent venous thromboembolism, major bleeding, and/or all-cause mortality) were evaluated. The relative risk (RR) for 14- and 30-day mortalities and adverse events is calculated in subgroups using a random effects model.The 14- and 30-day mortalities were 0.11% [95% confidence interval (CI) 0.0-0.24, I2 = 0) and 0.30% (95% CI 0.09-0.51, I2 = 0). The 14- and 30-day incidences of adverse events were 0.56% (95% CI 0.28-0.84, I2 = 0) and 1.2% (95% CI 0.79-1.6, I2 = 0). Cancer was associated with increased 30-day mortality [RR 4.9; 95% prediction interval (PI) 2.7-9.1; I2 = 0]. Pre-existing cardiopulmonary disease, abnormal troponin, and abnormal (N-terminal pro-)B-type natriuretic peptide [(NT-pro)BNP] at presentation were associated with an increased incidence of 14-day adverse events [RR 3.5 (95% PI 1.5-7.9, I2 = 0), 2.5 (95% PI 1.3-4.9, I2 = 0), and 3.9 (95% PI 1.6-9.8, I2 = 0), respectively], but not mortality. At 30 days, cancer, abnormal troponin, and abnormal (NT-pro)BNP were associated with an increased incidence of adverse events [RR 2.7 (95% PI 1.4-5.2, I2 = 0), 2.9 (95% PI 1.5-5.7, I2 = 0), and 3.3 (95% PI 1.6-7.1, I2 = 0), respectively].The incidence of adverse events in home-treated PE patients, selected by a validated triage tool, was very low. Patients with cancer had a three- to five-fold higher incidence of adverse events and death. Patients with increased troponin or (NT-pro)BNP had a three-fold higher risk of adverse events, driven by recurrent venous thromboembolism and bleeding.© The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology.