Advancing Care for Pulmonary Embolism with a Team Approach
“What did you do?”, remarked the patient, “it feels like a 300-pound weight has been lifted off my chest.” Her statement came while undergoing a catheter procedure to remove a blood clot, also known as a pulmonary embolism (PE), from her chest. Just hours before, she was on a long plane flight from California to New York, where she began to struggle to breathe. Her symptoms signaled that she was experiencing a potentially life-threatening PE.
Pulmonary embolism (PE) is a blood clot that forms or travels to the lung, depriving the body of oxygen and lowering blood pressure by causing severe strain on the heart. PE can be minor, resolving with medications like blood thinners, or it can be life-threatening, requiring immediate invasive intervention. More than 10% of cases can be fatal within one hour of symptom onset, and if untreated, the rate of mortality can be 50% or more.
Today PE is recognized as the 3rd leading cause of cardiovascular death, affecting a diverse population of people ranging from early to late adulthood and manifested across sex, races and ethnicities.
Identifying and treating PE is a unique challenge for clinicians. The awareness of famous people diagnosed with PE like Serena Williams have helped expose PE as a dangerous disease that has the potential to affect anybody – even elite athletes. Genetic and environmental risk factors, or blood conditions can also put otherwise healthy people at increased risk. Symptoms can present variably and range in intensity, leading patients to delay in diagnosis and proper treatment. Historically, the disease has been misunderstood, with most fatal cases found to be misdiagnosed during autopsy. PERT programs are changing that.
PERT Programs
PERT stands for Pulmonary Embolism Response Team. PERT programs are designed to facilitate timely intervention in critically ill patients.
“The rapid onset and clinical complexity of PE demands a networked approach, where multiple specialists collaborate to triage and diagnose a patient, and then consult on the best therapies,” says Dr. Sahil Parikh, who spearheaded the PERT program at NewYork-Presbyterian/Columbia University Irving Medical Center. “The consultation process becomes the algorithm – the method designed to initiate a rapid and accurate clinical response.”
A full-fledged PERT program consists of team members from Emergency Medicine, Vascular Medicine, Interventional Cardiology, Pulmonary Hypertension/Heart Failure, Imaging, Nursing, Quality and Safety, Research, Pharmacy, and more. Each member plays a role in assessing and helping the patient appropriately.
According to Dr. Sanjum Sethi, leader of the Columbia PERT team, “this multidisciplinary collaboration is vital to provide excellent and appropriate care for our patients in a timely manner.” Comprehensive PERTs don’t just see and treat a patient at a single point in time. Rather, the team remains committed to the patient, following up after discharge to assess the patient’s well-being weeks and months onward.
Taking wisdom from the first PERT team which began at Massachusetts General Hospital in 2012, Dr. Parikh and Dr. Sethi have further developed the strategy here at Columbia. Under Dr. Sethi’s leadership, the volume of patients seen by the team has doubled, and he and his colleagues have engaged in national and international research, helping to establish PERT from a movement into a field.
Going forward, the program continues to prove it is critical, as care is becoming more uniform, doctors are distinguishing between pharmaceutical and invasive treatment, and researchers are refining technical device outcomes with innovative product designs. The group is very active in research addressing treatment outcome disparities, the Covid-19 response, new device evaluations, and more.
For more information on the PERT program, please visit our Vascular and Endovascular Care page.
Related