Key elements of follow-up care after acute pulmonary embolism focusing on long term sequelae: a Delphi study among European experts

R M A Mali; M K Ninaber; T E van Mens; S V Konstantinides; F A Klok

doi:10.1093/ehjqcco/qcaf053

Key elements of follow-up care after acute pulmonary embolism focusing on long term sequelae: a Delphi study among European experts

Eur Heart J Qual Care Clin Outcomes. 2025 Jul 1:qcaf053. doi: 10.1093/ehjqcco/qcaf053. Online ahead of print.

Authors

R M A Mali¹, M K Ninaber², T E van Mens¹, S V Konstantinides³, F A Klok^{1

3}

Affiliations

¹ Department of Medicine - Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands.
² Department of Pulmonology, Leiden University Medical Center, Leiden, the Netherlands.
³ Center for Thrombosis and Hemostasis, University Medical Center, Mainz, Germany.

PMID: 40590243
DOI: 10.1093/ehjqcco/qcaf053

Abstract

Background: A considerable proportion of patients develop long-term sequelae after an acute pulmonary embolism (PE). Beyond chronic thrombo-embolic pulmonary hypertension (CTEPH), current guidelines provide limited guidance regarding a structured approach for assessment and management of these patients.

Objectives: To establish a framework of multidisciplinary follow-up care of PE-survivors.

Methods: A Delphi study was conducted among a multidisciplinary panel of PE specialists from across Europe to gather expert opinions, and where possible reach consensus, on key aspects of PE follow-up care.

Results: Two rounds of surveys were distributed among 45 venous thromboembolism (VTE) experts, with 39 completing both rounds. Consensus was reached that follow-up of PE survivors should address the entire spectrum of post-PE sequelae, i.e., CTEPH, chronic thromboembolic pulmonary disease, but also all other presentations of the post-PE syndrome. Routine assessment at three months should involve patient-reported outcome measures, including quality of life. A single, uniform protocol was preferred over locally adapted approaches. Earlier follow-up, prior to the three-month mark, to detect post-PE sequelae was not considered necessary for most patient subgroups. Right heart catheterization to confirm CTEPH should be reserved for specialized pulmonary hypertension centers, while other diagnostic modalities such as computed tomography, V/Q scan, cardiopulmonary exercise testing and transthoracic echocardiography can be performed in non-referral centers.

Conclusion: This Delphi study among a panel of VTE experts across Europe describes a consensus-based framework for structured follow-up care for PE-survivors, emphasizing the need for a standardized, multidisciplinary approach to detecting long-term sequelae of PE.

Keywords: Pulmonary embolism; consensus; echocardiography; prognosis; pulmonary hypertension; respiratory function tests.