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Pulmonary EmbolismHOME-PENCT02811237

Hospitalization or Out-treatment ManagEment of Patients With Pulmonary Embolism: a Randomized Controlled Trial

A study testing HESTIA and sPESI in people with Pulmonary Embolism, run by University Hospital, Angers at 28 sites in 5 countries.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
Search all trials

Trial summary

Several studies have demonstrated the possibility of outpatient management or early discharge for certain patients presenting acute pulmonary embolism (PE), providing a suitable structure is in place. Read more about this study

Who is it for?
Ages 18 years and older
Conditions the study is for
Pulmonary Embolism
What is being tested?
HESTIA and sPESI
Could I receive a placebo?
No, everyone receives an active treatment
How many people
1,975 participants
Where
28 sitesin 5 countries
Study dates
Jan 2017to 30 Oct 2019
Phase
Interventional
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Admission to Emergency Department or unscheduled consultation in one of the participating centres;
  • Symptomatic pulmonary embolism objectively confirmed according to the European Society of Cardiology criteria
  • Insurance cover according to local legislation;
  • Age ≥18 years;
  • Free informed consent according to local legislation

Who cannot join

  • Shock or hypotension defined as systolic blood pressure <90 mmHg or a systolic pressure drop by ≥40 mmHg, for >15 minutes, if not caused by new-onset arrhythmia, hypovolaemia, or sepsis;
  • Diagnosis of pulmonary embolism established more than 24H before inclusion;
  • More than 48h between first presentation to the Emergency unit and inclusion - - Factors rendering 30-day follow-up impossible;

Trial locations and contacts

28 sites in 5 countries.

28 sites in 5 countries

France16 sites
  • Angers University Hospital

    Angers, 49933

  • Hia Brest

    Brest, 29240

  • CHU Brest

    Brest

  • CHU Clermont-Ferrand

    Clermont-Ferrand

  • APHP Louis Mourier

    Colombes

  • CHU Dijon

    Dijon

  • CHU Grenoble

    Grenoble

  • Thibault Schotté

    Le Mans

  • CHU de Montpellier

    Montpellier

  • APHP Cochin

    Paris

  • APHP Hôpital Européen Georges Pompidou

    Paris

  • APHP Lariboisière

    Paris

  • CHU de Rouen

    Rouen

  • CHU Saint Etienne

    Saint-Etienne

  • CH Toulon

    Toulon

  • CHU Toulouse

    Toulouse

Other trials in France

Belgium5 sites
  • Cliniques Universitaires Saint-Luc

    Brussels

  • Hôpital Erasme

    Brussels

  • Hôpital Saint-Pierre

    Brussels

  • CHU de Liège

    Liège

  • Hôpital de Namur

    Namur

Other trials in Belgium

Netherlands4 sites
  • Red Cross Hospital

    Beverwijk, 1942 LE

  • TERGOOI

    Hilversum, 1213 XZ

  • Leiden University Medical Center Leiden,

    Leiden

  • University Medical Center Utrecht

    Utrecht, 3584 CX

Other trials in Netherlands

Switzerland2 sites
  • Hôpital de Genève

    Geneva

  • Hôpital de Lausanne

    Lausanne

Other trials in Switzerland

Spain1 site
  • Ramon y Cajal Hospital

    Madrid

Other trials in Spain

About this study

Official title: Criteria for Hospitalization or Outpatient Management of Patients With Pulmonary Embolism, Hestia Rule Versus Simplified PESI Score : an Open-label Controlled Randomized International Trial (HOME-PE)

Several studies have demonstrated the possibility of outpatient management or early discharge for certain patients presenting acute pulmonary embolism (PE), providing a suitable structure is in place.

The approach featured in the most recent guidelines on acute PE of the European Society of Cardiology, refers to an all-cause mortality risk assessment using the Pulmonary Embolism Severity Index (PESI) score or the simplified PESI score (sPESI). The sPESI takes into account demographics (age), patient history (cancer, cardiac or respiratory disease), and clinical data (systolic blood pressure, heart rate, oxygen saturation). Outpatient care is offered to low-risk patients, providing that all the conditions pertaining to start anticoagulant treatment and follow-up at home are met.

Read more

An alternative approach based on a list of simple criteria has been developed as the one used in HESTIA study. The main criteria included in the HESTIA rule consist of absence of the following: hemodynamic instability, need for oxygen therapy, high-risk of hemorrhage, renal or liver failure, or other medical or social conditions requiring hospitalization.

The investigators hereby propose comparing these two approaches in an open-label, controlled randomized international trial with blinded adjudication of endpoints.

The main objective is to demonstrate, in normotensive PE patients, that a strategy based on the HESTIA rule compared to a strategy based on the simplified PESI score is at least as safe as regards the 30-day-rate of adverse events (recurrent VTE, major bleeding or death).

The major secondary objectives are to demonstrate, in normotensive PE patients, that a strategy based on the HESTIA rule compared to a strategy based on the simplified PESI score is more effective :

  • As regards the rate of patients eventually managed as outpatients.
  • As regards the rate of patients, in theory, eligible for outpatient care,
Read the detailed description

All patients admitted in the Emergency Department of the participating centres and diagnosed with PE will be eligible and assessed for potential inclusion.

Included patients will be randomized into two groups (1:1) and stratified by centre. Data will be recorded in a computerized case report form (e-CRF) enabling the randomization.

The HESTIA group will receive outpatient care proposal based on HESTIA criteria. The sPESI group will receive outpatient care proposal based on the simplified PESI score. Any reason for management (hospitalization or outpatient treatment) not based on the recommendation will be explained and documented in the e-CRF.

Follow-up will occur within 72 hours after inclusion, at 14 days, 1 month, and 3 months in both groups to gather clinical event data (recurrent VTE, major bleeding, death), treatment data, unscheduled hospitalizations and patient satisfaction assessment results.

The major objectives will test HESTIA based strategy versus sPESI based strategy in a hierarchical approach:

  • step 1: non-inferiority analysis on the rate of adverse events,
  • if yes, step 2: superiority analysis on the rate of patients managed as outpatients,
  • if yes, step3: superiority analysis on the rate of patients, in theory, eligible for outpatient care.
Being tested
HESTIA, sPESI
Medical subject headings
Pulmonary Embolism

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • HESTIAOther

    Management based on the HESTIA rule:

    • If the rule is negative, meaning that patient meet none of the exclusion criteria of the rule, the proposed management will be outpatient care.
    • In the other cases, the patient will receive in-hospital care.

    Any reason for management (hospitalization or outpatient treatment) not based on the recommendation will be explained and documented in the e-CRF.

  • sPESIOther

    Management based on the simplified PESI score:

    • If the sPESI score =0, the proposed management will be outpatient care.
    • In the other cases, the patient will receive in-hospital care.

    Any reason for management (hospitalization or outpatient treatment) not based on the recommendation will be explained and documented in the e-CRF.

Study groups in NCT02811237
Study groupRoleWhat they receive
HESTIA groupOtherNot described
Receives: Other: HESTIA
sPESI groupOtherNot described
Receives: Other: sPESI

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. The rate of the composite of recurrent VTE, major bleeding and all cause death at 30 days

    • Recurrent VTE: objectively confirmed pulmonary embolism or deep venous thrombosis objectively confirmed.
    • Major bleeding: according to the International Society on Thrombosis and Haemostasis' criteria.
    • Death: all-cause mortality.

    Measured: 30 days

Secondary outcomes (13)
  1. The rate of patients actually managed as outpatients (meaning patients discharged home within 24 hours after the inclusion in the study (first major secondary objective))

    The rate of patients managed as outpatients defined by patients discharged home within 24 hours after the inclusion in the study.

    Measured: 1 day

  2. The rate of "low-risk" patients in theory eligible for outpatient care (second major secondary objective)

    The rate of "low-risk" patients eligible for outpatient care:

    • HESTIA group: patients meeting none of the exclusion criteria of the rule (HESTIA rule negative);
    • sPESI group: patients with a simplified PESI score =0.

    Measured: 1 day

  3. Safety endpoints - Rate of cumulative events

    The rate of the composite of recurrent VTE, major bleeding and all-cause death,

    Measured: 14 days, 30 days, 90 days

  4. Safety endpoints - Recurrent VTE

    The rate of recurrent VTE

    Measured: 14 days, 30 days, 90 days

  5. Safety endpoints - Suspected recurrent VTE

    The rate of recurrent VTE suspicion

    Measured: 14 days, 30 days, 90 days

  6. Safety endpoints - Major Bleeding

    The rate of major bleeding

    Measured: 14 days, 30 days, 90 days

  7. Safety endpoints - Non major bleeding

    The rate of non-major clinically relevant bleeding

    Measured: 14 days, 30 days, 90 days

  8. Safety endpoints - Death

    The rate of all-cause death

    Measured: 14 days, 30 days, 90 days

  9. Safety endpoints - Serious adverse event

    The rate of serious adverse event as defined in good clinical practice

    Measured: 14 days, 30 days, 90 days

  10. Applicability of management strategies

    The rate of patients actually managed as outpatients among number of patientpatients eligible for outpatient management

    Measured: 1 day

  11. Resources utilization

    Resources utilization will be assessed via the cumulative in-hospital length of stay (LOS) defined as the LOS for initial hospitalization plus LOS of possible unscheduled hospitalizations in the 30 days and 3 months following admission.

    Measured: Day 90

  12. Patient satisfaction with care

    A specific questionnaire will be used at 30 days following inclusion:

    • Anti-Clot Treatment - Specific Questionnaire (ACTS)

    Measured: 30 days

  13. Patient quality of life

    A specific questionnaire will be used at 30 days following inclusion:

    • Patient-reported Pulmonary Embolism Quality of Life Questionnaire (PEmb-QoL).

    Measured: 30 days

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted23 Jun 2016 (estimated)
  2. Study startJan 2017
  3. Primary completionJul 2019
  4. Study completion30 Oct 2019

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Other
Allocation
Randomised
Intervention model
Parallel groups
Masking
None (open label)
Enrolment
1,975 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT02811237
Sponsor's protocol ID
PHRC 2015-04
Acronym
HOME-PE
Status last verified
Oct 2019
First submitted
7 Jun 2016
Last updated
1 Nov 2019
Results posted
No
Data monitoring committee
Yes

Publications

  • Piran S, Le Gal G, Wells PS, Gandara E, Righini M, Rodger MA, Carrier M. Outpatient treatment of symptomatic pulmonary embolism: a systematic review and meta-analysis. Thromb Res. 2013 Nov;132(5):515-9. doi: 10.1016/j.thromres.2013.08.012. Epub 2013 Aug 28.

    PubMed 24035045
  • Zondag W, Kooiman J, Klok FA, Dekkers OM, Huisman MV. Outpatient versus inpatient treatment in patients with pulmonary embolism: a meta-analysis. Eur Respir J. 2013 Jul;42(1):134-44. doi: 10.1183/09031936.00093712. Epub 2012 Oct 25.

    PubMed 23100493
  • Konstantinides SV, Torbicki A, Agnelli G, Danchin N, Fitzmaurice D, Galie N, Gibbs JS, Huisman MV, Humbert M, Kucher N, Lang I, Lankeit M, Lekakis J, Maack C, Mayer E, Meneveau N, Perrier A, Pruszczyk P, Rasmussen LH, Schindler TH, Svitil P, Vonk Noordegraaf A, Zamorano JL, Zompatori M; Task Force for the Diagnosis and Management of Acute Pulmonary Embolism of the European Society of Cardiology (ESC). 2014 ESC guidelines on the diagnosis and management of acute pulmonary embolism. Eur Heart J. 2014 Nov 14;35(43):3033-69, 3069a-3069k. doi: 10.1093/eurheartj/ehu283. Epub 2014 Aug 29. No abstract available.

    PubMed 25173341
  • Aujesky D, Roy PM, Verschuren F, Righini M, Osterwalder J, Egloff M, Renaud B, Verhamme P, Stone RA, Legall C, Sanchez O, Pugh NA, N'gako A, Cornuz J, Hugli O, Beer HJ, Perrier A, Fine MJ, Yealy DM. Outpatient versus inpatient treatment for patients with acute pulmonary embolism: an international, open-label, randomised, non-inferiority trial. Lancet. 2011 Jul 2;378(9785):41-8. doi: 10.1016/S0140-6736(11)60824-6. Epub 2011 Jun 22.

    PubMed 21703676
  • Zondag W, Mos IC, Creemers-Schild D, Hoogerbrugge AD, Dekkers OM, Dolsma J, Eijsvogel M, Faber LM, Hofstee HM, Hovens MM, Jonkers GJ, van Kralingen KW, Kruip MJ, Vlasveld T, de Vreede MJ, Huisman MV; Hestia Study Investigators. Outpatient treatment in patients with acute pulmonary embolism: the Hestia Study. J Thromb Haemost. 2011 Aug;9(8):1500-7. doi: 10.1111/j.1538-7836.2011.04388.x.

    PubMed 21645235
  • Roy PM, Penaloza A, Hugli O, Klok FA, Arnoux A, Elias A, Couturaud F, Joly LM, Lopez R, Faber LM, Daoud-Elias M, Planquette B, Bokobza J, Viglino D, Schmidt J, Juchet H, Mahe I, Mulder F, Bartiaux M, Cren R, Moumneh T, Quere I, Falvo N, Montaclair K, Douillet D, Steinier C, Hendriks SV, Benhamou Y, Szwebel TA, Pernod G, Dublanchet N, Lapebie FX, Javaud N, Ghuysen A, Sebbane M, Chatellier G, Meyer G, Jimenez D, Huisman MV, Sanchez O; HOME-PE Study Group. Triaging acute pulmonary embolism for home treatment by Hestia or simplified PESI criteria: the HOME-PE randomized trial. Eur Heart J. 2021 Aug 31;42(33):3146-3157. doi: 10.1093/eurheartj/ehab373.

    PubMed 34363386

Questions about this trial

What is this clinical trial studying?

A study testing HESTIA and sPESI in people with Pulmonary Embolism, run by University Hospital, Angers at 28 sites in 5 countries.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 5 inclusion and 3 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 1 Nov 2019. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 28 sites in France, Belgium, Netherlands, Switzerland, Spain. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

The rate of the composite of recurrent VTE, major bleeding and all cause death at 30 days (time frame: 30 days). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT02811237, which also lists 6 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 1 Nov 2019.

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