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HWN Suggests

Prognostic Performance of Hestia Criteria in Acute Pulmonary Embolism: A Systematic Review and Meta-Analysis

Our meta-analysis demonstrates that the Hestia criteria can effectively identify PE patients at low risk of poor prognosis with high sensitivity and NPV, and it can be suited for use in routine clinical practice, eligible patients can be safely treated at home, with a low rate of complications. However, its value of guiding management of PE patients at intermediate or high-risk group and the prognostic performance compared with other models are still needed to be validated.

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  Hestia Criteria

Identifies low-risk PE patients safe for outpatient treatment.

 HESTIA, Simplified PESI Comparable for Triage to Outpatient PE Treatment: HOME-PE

Using either score, more than one-third of patients could be managed safely at home.

Articles of Interest

External Validation of the Hestia Criteria for Identifying Acute Pulmonary Embolism Patients at Low Risk of Early Mortality

The Hestia criteria demonstrated acceptable predictive accuracy for identifying patients with PE at low risk of early mortality. The sensitivity and NPV of the Hestia criteria remained high in advanced age patients and those concomitantly diagnosed with active cancer or cardiopulmonary disease. Additional prospective external validation studies of the Hestia criteria should be performed.

Hestia criteria can discriminate high- from low-risk patients with pulmonary embolism

The Hestia criteria can be used to discriminate PE patients with low risk for adverse clinical outcome from patients with high risk for adverse clinical outcome. The low-risk patients can be safely treated at home.

HESTIA Rule vs. Simplified PESI for Home Treatment of Patients With Acute Pulmonary Embolism - HOME-PE

Among patients with PE, risk stratification with the HESTIA rule was noninferior to the PESI score on all-cause death, recurrent VTE, or major bleeding. The two strategies were similar regarding the proportion of patients treated at home. By using risk stratification, approximately one-third of low-risk patients with PE could be safely managed at home.

Outpatient treatment in patients with acute pulmonary embolism: the Hestia Study

Traditionally, patients with pulmonary embolism (PE) are initially treated in the hospital with low molecular weight heparin (LMWH). The results of a few small non-randomized studies suggest that, in selected patients with proven PE, outpatient treatment is potentially feasible and safe.

Pulmonary embolism diagnosis & treatment of low-risk PE

A HESTIA score of zero is generally regarded as the primary tool to determine if outpatient management is reasonable. Of course, this must be combined with clinical judgement. Appropriately selected patients may be discharged home on an oral Xa inhibitor (e.g., apixaban, rivaroxaban).

The Hestia Score & Outpatient Treatment of Pulmonary Embolism

After you update Mr. X and his family on the results, they ask about next steps– will he need to stay in the hospital, or can he go home? You ponder this question, thinking about his malignancy, the evidence of mild right heart strain, and his age. You recall that one of your residency classmates had been talking about a scoring system to identify patients who could go home on oral anticoagulants after a PE diagnosis, so you open up MD Calc on your phone and start scrolling…