- Design
- Quasi-cluster randomised trial of a clinician alert
- Population
- 400 outpatients with prior pulmonary embolism and persistent symptoms; 73 clinicians
- Primary outcome
- Echocardiography within 90 days
- Effect
- 32.5% vs 17.5%; adjusted OR 2.23 (95% CI 1.58–3.15)
Chronic thromboembolic pulmonary hypertension is often diagnosed late because breathlessness after a pulmonary embolism is easy to put down to deconditioning. CTEPH-DETECT tested whether a computerised alert would prompt physicians to order an echocardiogram.
Seventy-three clinicians caring for 400 outpatients were assigned, in a quasi-cluster randomised design, to receive an alert or not. Patients were at least six months past a pulmonary embolism, had persistent or new symptoms or unexplained abnormal lung tests, and had no recent echo. Echo was ordered for 32.5% with the alert and 17.5% without (adjusted OR 2.23). Pulmonary hypertension on echo was found in 10.5% versus 5.0%. No new formal diagnosis of chronic thromboembolic pulmonary hypertension was made in either group within the study.
The practical point does not need software: a patient still breathless months after a pulmonary embolism deserves an echo, and a reminder roughly doubled how often that happened.
- Ask every patient seen three to six months after a pulmonary embolism about breathlessness and exercise limitation.
- Consider an echocardiogram when symptoms persist with no other explanation.
- Refer to a pulmonary hypertension service if echo suggests raised pressures.
- Build a follow-up prompt into discharge letters after pulmonary embolism.
Why it matters
Persistent breathlessness after pulmonary embolism is under-investigated, and a simple prompt changes that.
Don't overread it
The trial found no new chronic thromboembolic pulmonary hypertension, so patient benefit is unproven.
The statistics, in plain English
An adjusted odds ratio of 2.23 means the alert roughly doubled the odds of an echo being ordered. Quasi-randomisation is weaker than true randomisation, and the study measured ordering and echo findings, not whether patients did better.
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