The American Heart Association (AHA) and American College of Cardiology (ACC) have released their first guidelines on acute pulmonary embolism, unveiling a new clinical classification system to help guide management.

The guidelines, which were a joint collaboration between the ACC, AHA, and several other organizations, outline recommendations on diagnosis and treatment to improve outcomes.

“Both general cardiologists and interventional cardiologists are often involved in the management of patients with acute pulmonary embolism. This guideline will serve as an important resource for cardiologists, as well as others who care for these patients,” Mark A. Creager, MD, chair of the writing committee, told Medscape Medical News.

“The emphasis on multidisciplinary care, along with guidance regarding the appropriate clinical settings for managing patients across the spectrum of pulmonary embolism severity, gives clinicians a practical framework to optimize treatment decisions, coordinate care, and improve patient outcomes,” said Edwin Takahashi, MD, a peer reviewer of guidelines.

Designed With Precision in Mind

The guidelines feature a new clinical classification scheme titled “Acute Pulmonary Embolism Clinical Categories.” The scheme includes five risk categories — A through E, with E being the highest risk — and several subcategories.

The authors wrote that the classification system was created “to enhance the precision of severity classification, prognosis assessment, and evidence-based therapeutic decision-making for patients presenting with acute pulmonary embolism.…The categories build on previous risk schemes by incorporating clinical, hemodynamic, and respiratory factors, along with biomarkers and assessment of right ventricular size and function.”

Comprehensive Recommendations

Creager, who is a professor of medicine and surgery at Geisel School of Medicine at Dartmouth in Hanover, New Hampshire, explained that the recommendations also cover the clinical assessment of patients presenting with symptoms and signs of acute pulmonary embolism, initial laboratory testing, and the appropriate use of imaging for diagnosis.

The guidelines also address referred care setting, which Creager said depends on the severity of the clinical presentation.

For example, he said, patients who are asymptomatic (Category A) or those who are symptomatic but have a low clinical severity score (Category B) can usually be safely discharged home.

Conversely, symptomatic patients with an elevated clinical severity score, including those with elevated biomarkers or right ventricular dysfunction (Category C), incipient cardiopulmonary failure (Category D), and cardiopulmonary failure characterized by persistent hypertension (Category E), require hospitalization to optimize treatment strategies, Creager said.

The guidelines cover when to use a multidisciplinary pulmonary embolism response team, or PERT, care delivery model.

“In patients with acute pulmonary embolism who are at increased risk of adverse outcomes (i.e., Categories C-E), a multidisciplinary pulmonary embolism response team assessment is recommended to improve in-hospital clinical care delivery,” Creager said.

Management strategies reviewed include anticoagulant therapy, inferior vena cava filters, and advanced therapies, such as systemic thrombolysis, catheter-directed thrombolysis, mechanical thrombectomy, and surgical thrombectomy.

Creager advised all cardiologists to familiarize themselves with the recommendations, which also address follow-up care and evidence gaps, along with the research used to support the recommendations.

A ‘Rapidly Evolving’ Field

Takahashi, who is a physician at the Mayo Clinic in Rochester, Minnesota, suggested cardiologists stay tuned for more developments in the field of pulmonary embolism care as it is rapidly evolving.

“Exciting clinical trials investigating different treatment strategies are currently underway,” Takahashi said. “New data will emerge within the next few years that will help to refine our knowledge on optimal therapeutic approaches to PE so clinicians can deliver well-informed, evidence-based care for patients.”

Creager and Takahashi reported having no relevant financial relationships.

Brian Ellis is a freelance writer and editor who lives in Southwest Virginia.