An alert after pulmonary embolism doubled echo screening for pulmonary hypertension

Design

Quasi-cluster randomised trial of a clinician alert

Population

400 outpatients ≥6 months after pulmonary embolism with possible pulmonary hypertension features

Primary outcome

Echocardiographic screening within 90 days

Effect

32.5% vs 17.5%; aOR 2.23 (95% CI 1.58–3.15)

CTEPH-DETECT was a quasi-cluster randomised trial in which 73 clinicians caring for 400 outpatients were allocated to receive, or not, an electronic alert. Eligible patients had a pulmonary embolism at least six months earlier, persistent or new symptoms or signs suggesting pulmonary hypertension or unexplained abnormal pulmonary tests, and no echocardiogram in the previous six months.

Echocardiography was ordered for 32.5% of patients in the alert group against 17.5% in the control group (aOR 2.23, 95% CI 1.58–3.15). Pulmonary hypertension on echo was found in 10.5% against 5.0%. No patient in either arm received a formal diagnosis of chronic thromboembolic pulmonary hypertension during the trial.

The trial shows that a simple prompt changes ordering behaviour and uncovers more pulmonary hypertension. It does not yet show better outcomes. The underlying lesson is older: breathlessness that persists months after a pulmonary embolism deserves an echocardiogram, not reassurance.

• At follow-up three to six months after pulmonary embolism, ask specifically about breathlessness and exercise limitation.
• Consider echocardiography for patients with persisting or new symptoms after anticoagulation.
• An echo suggesting pulmonary hypertension after embolism warrants referral for ventilation–perfusion scanning and specialist review.
• Two-thirds of eligible patients in the alert group still had no echo ordered; prompts help but do not replace a follow-up plan.

Why it matters

Chronic thromboembolic pulmonary hypertension is treatable but usually found late because no one looks.

Don't overread it

The alert increased screening and echo findings; it did not show fewer deaths or more confirmed CTEPH.

The statistics, in plain English

An adjusted odds ratio of 2.23 means the odds of an echo being ordered were a little over double with the alert. Because clinicians rather than patients were allocated and allocation was quasi-random, the result is less secure than a fully randomised trial.

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