Table 2 Open in new tab Characteristics...

Table 2

Characteristics of included studies

Study	Primary study aim	Study period	Selection of low-risk patients	Follow-up (days)	Outcome adjudication	PE patients treated at home according to the study definition of home treatment, n (% of total study population)	PE patients treated at home according to the IPDMA definition of home treatment, n (% of previous column)
Barco et al.²⁵ (HoT-PE)	Evaluate the efficacy and safety of home treatment in low-risk acute PE patient treated with rivaroxaban	May 2014–June 2018	Negative Hestia rule and no RV dysfunction or intra-cardiac thrombi	90	Yes	520 (100)^a	170 (32)ⁱ
Bledsoe et al.³	Evaluate the efficacy and safety outpatient treatment in low-risk acute PE patients	January 2013–October 2016	PESI Class I or II with a list of exclusion criteria including RV dysfunction on echocardiography	90	No	200 (100)^b	192 (96)ⁱ
den Exter et al.²⁸ (Vesta)	Evaluate the utility and safety of the Hestia rule vs. Hestia rule in combination with (NT-pro)BNP testing for selection of outpatient PE treatment	December 2010–February 2014	Negative Hestia rule with/without negative (NT-pro)BNP testing	90	Yes	513 (93)^c	513 (100)^j
Font et al.²⁷	Evaluate the feasibility of outpatient treatment in patients with cancer and PE	May 2006–December 2009	Negative Hestia-like criteria: systolic blood pressure < 100 mmHg, arterial oxygen pressure < 60 mmHg or pulse oximetry < 90%, active bleeding, platelet count ≥50 000/mm³, renal failure, lack of social support, poor treatment compliance, or the presence of other admission criteria according to treating physicians	90	Yes	62 (45)^d	62 (100)^d
Kabrhel et al.²⁹	Determine whether a protocol combining risk stratification, treatment with rivaroxaban, and defined follow-up is associated with a greater proportion of patients with VTE treated as outpatients	September 2015–unknown	Negative: social or psychological barrier, abnormal vital signs, coronary artery disease or congestive heart failure, elevated troponin, high risk of bleeding, large PE, intermediate PE with RV dysfunction, high-risk DVT	28	No	164 (25)^e	122 (74)^k
Kline et al.³⁰ (MATH-VTE)	Evaluate the safety and efficacy of home treatment with a DOAC in low-risk acute PE patient presented at the emergency department	April 2016–March 2019	Negative modified Hestia rule or sPESI of 0 plus physician’s judgement	30	No	604 (100)^f	604 (100)^f
Otero et al.²⁶	Evaluate efficacy and safety of early discharge in patients with low risk according to a clinical prediction rule	February 2005–April 2007	≤2 points on a clinical prediction score, haemodynamic instability, troponin ≥ 0.1 ng/mL, saturation < 93%, need for hospitalization for comorbidities, severe chronic obstructive pulmonary disease, severe asthma, active or high risk of bleeding, pregnancy, morbid obesity, or RV dysfunction	30	No	72 (55)^g	0 (0)^j
Roy et al.¹¹ (HOME-PE)	Evaluate safety and efficacy of Hestia vs. sPESI in the selection of outpatient PE treatment	January 2017–July 2019	Negative Hestia rule or sPESI of 0 (overruling by clinician possible)	30	Yes	739 (38)^h	681 (92)^k
Vinson et al.³¹ (eSPEED)	Evaluate the effect of an integrated electronic clinical decision support system to facilitate risk stratification and decision for selection of outpatient PE treatment	January 2014–April 2015	PESI Class I or II with a broad list of relative contraindications from variables from the Ottawa and Hestia exclusion criteria (including absence of RV dysfunction)	30	No	130 (19)^c	116 (89)^k
Zondag et al.^9,10 (Hestia)	Evaluate the efficacy and safety of outpatient treatment according to the Hestia rule in patients with acute PE	May 2008–April 2010	Negative Hestia rule	90	Yes	297 (100)^c	296 (100)^j

Study	Primary study aim	Study period	Selection of low-risk patients	Follow-up (days)	Outcome adjudication	PE patients treated at home according to the study definition of home treatment, n (% of total study population)	PE patients treated at home according to the IPDMA definition of home treatment, n (% of previous column)
Barco et al.²⁵ (HoT-PE)	Evaluate the efficacy and safety of home treatment in low-risk acute PE patient treated with rivaroxaban	May 2014–June 2018	Negative Hestia rule and no RV dysfunction or intra-cardiac thrombi	90	Yes	520 (100)^a	170 (32)ⁱ
Bledsoe et al.³	Evaluate the efficacy and safety outpatient treatment in low-risk acute PE patients	January 2013–October 2016	PESI Class I or II with a list of exclusion criteria including RV dysfunction on echocardiography	90	No	200 (100)^b	192 (96)ⁱ
den Exter et al.²⁸ (Vesta)	Evaluate the utility and safety of the Hestia rule vs. Hestia rule in combination with (NT-pro)BNP testing for selection of outpatient PE treatment	December 2010–February 2014	Negative Hestia rule with/without negative (NT-pro)BNP testing	90	Yes	513 (93)^c	513 (100)^j
Font et al.²⁷	Evaluate the feasibility of outpatient treatment in patients with cancer and PE	May 2006–December 2009	Negative Hestia-like criteria: systolic blood pressure < 100 mmHg, arterial oxygen pressure < 60 mmHg or pulse oximetry < 90%, active bleeding, platelet count ≥50 000/mm³, renal failure, lack of social support, poor treatment compliance, or the presence of other admission criteria according to treating physicians	90	Yes	62 (45)^d	62 (100)^d
Kabrhel et al.²⁹	Determine whether a protocol combining risk stratification, treatment with rivaroxaban, and defined follow-up is associated with a greater proportion of patients with VTE treated as outpatients	September 2015–unknown	Negative: social or psychological barrier, abnormal vital signs, coronary artery disease or congestive heart failure, elevated troponin, high risk of bleeding, large PE, intermediate PE with RV dysfunction, high-risk DVT	28	No	164 (25)^e	122 (74)^k
Kline et al.³⁰ (MATH-VTE)	Evaluate the safety and efficacy of home treatment with a DOAC in low-risk acute PE patient presented at the emergency department	April 2016–March 2019	Negative modified Hestia rule or sPESI of 0 plus physician’s judgement	30	No	604 (100)^f	604 (100)^f
Otero et al.²⁶	Evaluate efficacy and safety of early discharge in patients with low risk according to a clinical prediction rule	February 2005–April 2007	≤2 points on a clinical prediction score, haemodynamic instability, troponin ≥ 0.1 ng/mL, saturation < 93%, need for hospitalization for comorbidities, severe chronic obstructive pulmonary disease, severe asthma, active or high risk of bleeding, pregnancy, morbid obesity, or RV dysfunction	30	No	72 (55)^g	0 (0)^j
Roy et al.¹¹ (HOME-PE)	Evaluate safety and efficacy of Hestia vs. sPESI in the selection of outpatient PE treatment	January 2017–July 2019	Negative Hestia rule or sPESI of 0 (overruling by clinician possible)	30	Yes	739 (38)^h	681 (92)^k
Vinson et al.³¹ (eSPEED)	Evaluate the effect of an integrated electronic clinical decision support system to facilitate risk stratification and decision for selection of outpatient PE treatment	January 2014–April 2015	PESI Class I or II with a broad list of relative contraindications from variables from the Ottawa and Hestia exclusion criteria (including absence of RV dysfunction)	30	No	130 (19)^c	116 (89)^k
Zondag et al.^9,10 (Hestia)	Evaluate the efficacy and safety of outpatient treatment according to the Hestia rule in patients with acute PE	May 2008–April 2010	Negative Hestia rule	90	Yes	297 (100)^c	296 (100)^j

Since follow-up was only 28 days in the study by Kabrhel et al., we used 28 days as a surrogate measurement for incidence within 30 days for Kabrhel et al.²⁹

DOAC, direct oral anticoagulant; DVT, deep vein thrombosis; (NT-pro)BNP, N-terminal pro–B-type natriuretic peptide; PE, pulmonary embolism; PESI, pulmonary embolism severity index; RV, right ventricle; sPESI, simplified pulmonary embolism severity index; VTE, venous thromboembolism.

^aDischarge from the hospital within 48 h of presentation.

^bObservation or hospitalization for >12–<24 h.

^cDischarge from the hospital within 24 h of PE diagnosis.

^dDischarge within 12 h after PE diagnosis.

^eDischarged directly from the ED or admitted to the ED observation unit with a plan for discharge.

^fDischarge within 24 h after triage.

^gDischarge at 72 or 120 h (61 and 39%, respectively).

^hDischarge within 24 h of presentation or randomization.

ⁱWithin 24 h after randomization/inclusion.

^jWithin 24 h after acute PE diagnosis.

^kWithin 24 h after ED presentation.

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