hestia_criteria: Hestia Criteria for Outpatient Pulmonary Embolism Treatment

In cliot: Clinical Indices and Outcomes Tools

Hestia Criteria for Outpatient Pulmonary Embolism Treatment

Description

Evaluates the Hestia Criteria to determine if a patient with acute Pulmonary Embolism (PE) is eligible for outpatient management. If *any* of the 11 criteria are met (Yes), the patient is generally considered ineligible for home treatment and should be admitted. If all criteria are negative (No), the patient may be considered low risk and suitable for outpatient care.

Usage

hestia_criteria(hemodynamically_unstable, thrombolysis_needed, high_risk_bleeding,
                oxygen_needed_gt_24h, pe_on_anticoagulation, iv_pain_meds_needed,
                medical_social_reason, renal_failure, liver_failure, pregnancy,
                heparin_hit_history)

Arguments

hemodynamically_unstable	Numeric (0 or 1). Is the patient hemodynamically unstable? (SBP < 100 mmHg with HR > 100 bpm, or requiring ICU care). (1 = Yes).
thrombolysis_needed	Numeric (0 or 1). Is thrombolysis or embolectomy necessary? (1 = Yes).
high_risk_bleeding	Numeric (0 or 1). Active bleeding or high risk of bleeding (e.g., GI bleed < 14 days, recent stroke < 4 weeks, recent surgery < 2 weeks, bleeding disorder, platelets < 75k). (1 = Yes).
oxygen_needed_gt_24h	Numeric (0 or 1). Oxygen supply needed to maintain SaO2 > 90
pe_on_anticoagulation	Numeric (0 or 1). Pulmonary embolism diagnosed while on anticoagulant treatment? (1 = Yes).
iv_pain_meds_needed	Numeric (0 or 1). Severe pain requiring IV pain medication for more than 24 hours? (1 = Yes).
medical_social_reason	Numeric (0 or 1). Medical or social reason for admission (e.g., infection, cancer, no support system at home)? (1 = Yes).
renal_failure	Numeric (0 or 1). Creatinine clearance < 30 mL/min? (1 = Yes).
liver_failure	Numeric (0 or 1). Severe liver impairment? (1 = Yes).
pregnancy	Numeric (0 or 1). Is the patient pregnant? (1 = Yes).
heparin_hit_history	Numeric (0 or 1). Documented history of Heparin-Induced Thrombocytopenia (HIT)? (1 = Yes).

Value

A list containing:

Hestia_Result	Recommendation ("Eligible" vs "Not Eligible").
Criteria_Met_Count	Number of positive criteria (0 required for eligibility).
Criteria_List	List of specific exclusion criteria met.

References

Zondag W, Mos IC, Creemers-Schild D, et al. Outpatient treatment in patients with acute pulmonary embolism: the Hestia Study. J Thromb Haemost. 2011;9(8):1500-1507. doi:10.1111/j.1538-7836.2011.04388.x

Examples

# Example 1: Eligible for Outpatient
# All criteria No
hestia_criteria(0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0)

# Example 2: Ineligible (High Bleeding Risk)
# Bleeding risk = 1, others 0
hestia_criteria(0, 0, 1, 0, 0, 0, 0, 0, 0, 0, 0)

cliot documentation built on Dec. 1, 2025, 1:06 a.m.