A Survey of Submassive Pulmonary Embolism Treatment Preferences among Medical and Endovascular Physicians

Abstract

Purpose: To determine treatment preferences among endovascular and medical physicians who manage acute submassive pulmonary embolism (PE).

Materials and methods: From July through August 2016, 83 sites across the United States were surveyed, and 60 completed the survey. Endovascular and medical physicians were asked to rate their predilection for catheter-directed thrombolysis (CDT) on a 5-point scale and for systemic thrombolysis (ST) as "yes" or "no" in seven case scenarios of submassive PE. A CDT score ≥ 4 was considered to represent a predilection for CDT. Mean scores were used to compare CDT preferences between physicians. Percentages of physicians who preferred CDT or ST were calculated. P values < .05 were considered statistically significant.

Results: Across all scenarios (numbered S1-S7) combined, endovascular physicians had a significantly higher CDT score (mean, 3.52) than medical physicians (mean, 3.01; P < .0001). Scenario-by-scenario analysis revealed that the mean CDT score was significantly higher for endovascular physicians (S1, 4.25; S2, 3.72; S3, 2.82; S4, 2.68; S5, 3.45; S6, 3.67; S7, 4.02) compared with medical physicians (S1, 3.62 [P < .001]; S2, 3.18 [P < .001]; S3, 2.45 [P = .001]; S4, 2.37 [P = .011]; S5, 2.97 [P < .001]; S6, 3.20 [P < .001]; S7, 3.53 [P < .001]). Overall, a significantly higher percentage of endovascular physicians (56.7%) indicated a predilection for CDT compared with medical physicians (37.9%; P < .001). Also, a significantly higher percentage of physicians, regardless of specialty, indicated a predilection for CDT (47.2%) than did for ST (5.3%; P < .0001).

Conclusions: Endovascular physicians exhibited a greater predilection for CDT to treat acute submassive PE compared with their medical colleagues. Endovascular and medical physicians seemed to more frequently choose CDT than ST.