- Design
- Quasi-cluster randomised trial of an electronic alert
- Population
- 400 outpatients with prior pulmonary embolism and symptoms or test abnormalities, under 73 clinicians
- Primary outcome
- Echocardiographic screening within 90 days
- Effect
- 32.5% vs 17.5%; aOR 2.23 (95% CI 1.58–3.15)
Chronic thromboembolic pulmonary hypertension is a treatable complication of pulmonary embolism that is often recognised late because breathlessness after a clot is easy to attribute to deconditioning. CTEPH-DETECT tested whether an electronic alert could close that gap.
The trial assigned 73 clinicians caring for 400 outpatients to an alert or no alert. Patients had a pulmonary embolism at least six months earlier, persistent or new symptoms or signs of pulmonary hypertension or unexplained abnormal pulmonary tests, and no echocardiogram in the previous six months. The alert prompted echocardiography.
Echocardiography was ordered for 32.5% in the alert group and 17.5% without (adjusted OR 2.23, 95% CI 1.58–3.15). Pulmonary hypertension on echocardiography was found in 10.5% versus 5.0% (aOR 2.82). No patient in either group received a new formal diagnosis of chronic thromboembolic pulmonary hypertension during the study.
The design was quasi-randomised, the outcome was a process measure, and the trial was too small to show clinical benefit. Its main lesson does not depend on the alert: two-thirds of eligible patients still had no echocardiogram even when prompted, and many with symptoms after an embolism are never looked at again.
- Ask about breathlessness and exercise limitation at follow-up three to six months after a pulmonary embolism.
- Consider echocardiography when symptoms persist or are new beyond that point, rather than attributing them to deconditioning.
- Record the date of the embolism and the planned review in the discharge letter.
- Refer to a pulmonary hypertension service when echocardiography suggests raised pressures after an embolism.
Why it matters
It shows how easily persistent symptoms after a clot go unexamined in routine follow-up.
Don't overread it
No new cases of chronic thromboembolic pulmonary hypertension were diagnosed, so clinical benefit is unproven.
The statistics, in plain English
An adjusted odds ratio of 2.23 means the odds of an echo being ordered were about twice as high with the alert. The interval (1.58 to 3.15) is clear of 1.0. A process measure like ordering a test does not show that patients did better.
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