Christine Groth, BCCCP, PharmD, FCCM
Clinical Pharmacy Coordinator-Adult Critical Care and Emergency Medicine
Strong Memorial Hospital of the University of Rochester
Rochester, NY
Disclosure information not submitted.
Nicole Acquisto, BCCCP, PharmD
Emergency Medicine Clinical Pharmacy Specialist
Strong Memorial Hospital of the University of Rochester
Rochester, NY
Disclosure information not submitted.
Scott McNitt, MS
Senior Associate, Department of Medicine, Cardiology Heart Research and Department of Biostatistics
University of Rochester School of Medicine and Dentistry, New York, United States
Disclosure information not submitted.
Mark Marinescu, MD
Assistant Professor of Clinical Medicine - Department of Medicine , Cardiology
University of Rochester Medical Center, United States
Disclosure information not submitted.
Colin Wright, MD
Interventional Cardiologist
St. Elizabeth Hospital, United States
Disclosure information not submitted.
Ilan Goldenberg, MD
Professor, Department of Medicine, Cardiology Heart Research
University of Rochester School of Medicine and Dentistry, United States
Disclosure information not submitted.
Scott Cameron, MD, PhD
Section Head, Vascular Medicine
Cleveland Clinic Main Campus, United States
Disclosure information not submitted.
Title: Pharmacists as Members of an Interdisciplinary Pulmonary Embolism Response Team (PERT)
Introduction: Pulmonary embolism response teams (PERT) were developed to assist with diagnosis, risk stratification, and acute management of pulmonary embolism (PE) and have been shown to reduce 90-day mortality. The pharmacist’s role on PERT is not well defined. We hypothesized pharmacists can have an active role as a member of the PERT and would improve time from diagnosis to anticoagulation and increase anticoagulation with low molecular weight heparin (LMWH) versus unfractionated heparin (UFH).
Methods: Retrospective, observational study of adult patients with submassive or massive PE between January 2014 and May 2020. Patient demographics, history of present illness, anticoagulation treatment and timing, and pharmacist activities during PERT response were collected. Patients were divided into 3 groups for time to anticoagulation and heparinoid product use comparisons (pre-PERT vs. post-PERT with a pharmacist vs post-PERT without pharmacist). Kruskal-Wallis test or Wilcoxon rank-sum and Chi-squared analysis were used to compare continuous and categorical data, respectively.
Results: A total of 574 patients were included (mean age 63.2 ± 15.6 years, 54% male); 137 in the pre-PERT and 436 in the post-PERT groups. Within the post-PERT group, 305 patients (70%) were evaluated by a pharmacist. Most patients had submassive PE (n=449, 78%). In patients evaluated by a pharmacist, 222 (73%) had a documented intervention or activity related to patient care. Most (n=178, 58%) involved a pharmacist facilitating the ordering or administration of an anticoagulant or thrombolytic. Median time from diagnosis to anticoagulation (minutes [IQR]) was significantly reduced in the post-PERT groups (pre-PERT: 104 [124.5], post-PERT with a pharmacist: 63 [84], post-PERT without pharmacist: 75.5 [113], p=0.0001). Comparing the post-PERT groups with and without a pharmacist, there was a clinically significant but not statistically significant reduction in time to anticoagulation, p=0.45. More patients in the post-PERT groups received LMWH vs UFH when a pharmacist was present as part of the PERT compared to when they were not (69.5% vs 53.3%, p=0.002).
Conclusion: Pharmacists have an active role as a member of the PERT and can improve time from diagnosis to administration of anticoagulation and drive LMWH use.