First Comprehensive Guidelines for Acute Pulmonary Embolism Emphasize Timely Diagnosis and Treatment

The American Heart Association and American College of Cardiology have jointly published the first comprehensive clinical practice guidelines for acute pulmonary embolism, establishing standardized approaches for diagnosis, treatment, and follow-up care. This guideline introduces a new Acute Pulmonary Embolism Clinical Category system that classifies patients into five categories based on symptom severity and risk for adverse outcomes, which helps determine appropriate care settings from emergency department discharge to critical care hospitalization. According to the American Heart Association’s 2026 Heart Disease and Stroke Statistics, approximately 470,000 people are hospitalized with PE in the U.S. annually, with about 1 in 5 high-risk patients dying from the condition.

The guideline emphasizes that prompt diagnosis of acute PE is essential for timely treatment to prevent severe complications such as cardiac arrest and death. However, diagnosis is often challenging because symptoms like shortness of breath, chest pain, rapid heartbeat, fainting, and dizziness mimic other conditions. The document details risk factors that clinicians should assess, including major surgery or trauma, hospitalization, prolonged immobility, pregnancy and postpartum status, obesity, smoking, atherosclerotic cardiovascular disease, cancer, thrombophilias, and age over 40. For diagnostic testing, the guideline recommends D-dimer blood tests for patients with low or intermediate probability of acute PE, with computed tomography pulmonary angiography as the standard imaging test for confirmation.

Treatment recommendations prioritize direct oral anticoagulants over vitamin K antagonists for most patients due to their safety, ease of use, and reduced risk of major bleeding, though they are not recommended during pregnancy. Patients in higher risk categories may require advanced treatments including intravenous or catheter-based administration of clot-dissolving drugs, mechanical clot removal, or surgical intervention. The guideline acknowledges that implementation depends on local resource availability, including specialist consultations, imaging tests, and advanced interventions. Follow-up care recommendations include communication within one week of discharge, clinic visits by three months after diagnosis, and long-term monitoring for chronic thromboembolic pulmonary disease, which can develop in some patients.

Additional considerations address psychological health, with screening suggested for depression, anxiety, and post-traumatic stress disorder common in patients who have had acute PE. Physical activity recommendations encourage walking early in recovery once anticoagulant treatment has begun, while travel precautions advise frequent movement during long-haul travel and use of compression garments. The guideline was developed in collaboration with eight other healthcare organizations and is available in the American Heart Association’s flagship journal Circulation and in JACC, the flagship journal of the American College of Cardiology. More information about the guidelines can be found at https://www.heart.org and https://www.ACC.org.