{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T08:25:28Z","timestamp":1782894328442,"version":"3.54.5"},"reference-count":33,"publisher":"SAGE Publications","issue":"3","license":[{"start":{"date-parts":[[2026,3,31]],"date-time":"2026-03-31T00:00:00Z","timestamp":1774915200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,3,31]],"date-time":"2026-03-31T00:00:00Z","timestamp":1774915200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"name":"Sanofi Canada","award":["20160091"],"award-info":[{"award-number":["20160091"]}]},{"DOI":"10.13039\/100013711","name":"Bayer Canada","doi-asserted-by":"publisher","award":["20160091"],"award-info":[{"award-number":["20160091"]}],"id":[{"id":"10.13039\/100013711","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Vasc Med"],"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction:<\/jats:title>\n                    <jats:p>The simplified Pulmonary Embolism Severity Index (sPESI) is a validated tool for risk stratification in acute pulmonary embolism (PE). It incorporates heart rate (HR) \u2a7e 110 beats per minute (bpm) as a prognostic factor; however, recent evidence suggests that lower HR thresholds may also be clinically relevant. This study evaluated the prognostic performance of sPESI-based models using varying HR cut-offs and assessed the incremental value of adding right ventricular dysfunction (RVD).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>We conducted a retrospective cohort study of 696 outpatients with objectively confirmed PE between 2014 and 2019 in a Canadian health region. sPESI models were recalculated using HR thresholds of \u2a7e 80, \u2a7e 90, \u2a7e 100, and \u2a7e 110 bpm. The addition of imaging-confirmed RVD was also examined. Outcomes included 30- and 90-day all-cause mortality. Model performance was assessed using logistic regression, area under the curve (AUC), Youden\u2019s Index and net reclassification index (NRI).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>Lowering the HR threshold improved event detection and reclassification. HR \u2a7e 100 bpm provided the most balanced performance for 30-day mortality (AUC 74.7%, Youden Index 0.414), and HR \u2a7e 90 bpm offered greater sensitivity. Adding RVD modestly improved model discrimination, with sPESI + RVD at HR \u2a7e 80 bpm achieving the highest sensitivity (92.9%) and negative predictive value (&gt; 99%) for 30-day mortality. The strongest association with mortality was observed for sPESI alone HR \u2a7e 100 bpm (OR 2.06; 95% CI: 1.47\u20132.92). Findings remained consistent in a hospitalized-only sensitivity analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>Modifying HR thresholds within the sPESI model, particularly at \u2a7e 100 bpm, and incorporating RVD meaningfully improves short-term mortality prediction in acute PE. These refinements may enhance clinical decision-making, especially in selecting patients for safe outpatient management.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/1358863x261420329","type":"journal-article","created":{"date-parts":[[2026,3,31]],"date-time":"2026-03-31T12:21:22Z","timestamp":1774959682000},"page":"299-309","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Optimizing sPESI with heart rate threshold adjustments for risk stratification in acute pulmonary embolism: A retrospective cohort study"],"prefix":"10.1177","volume":"31","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2706-5395","authenticated-orcid":false,"given":"Kwadwo O","family":"Bonsu","sequence":"first","affiliation":[{"name":"School of Pharmacy, Memorial University of Newfoundland, St John\u2019s, NL, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephanie W","family":"Young","sequence":"additional","affiliation":[{"name":"School of Pharmacy, Memorial University of Newfoundland, St John\u2019s, NL, Canada"},{"name":"Pharmacy Program, Newfoundland and Labrador Health Services, St John\u2019s, NL, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tiffany A.","family":"Lee","sequence":"additional","affiliation":[{"name":"School of Pharmacy, Memorial University of Newfoundland, St John\u2019s, NL, Canada"},{"name":"Pharmacy Program, Newfoundland and Labrador Health Services, St John\u2019s, NL, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hai V","family":"Nguyen","sequence":"additional","affiliation":[{"name":"School of Pharmacy, Memorial University of Newfoundland, St John\u2019s, NL, Canada"},{"name":"Department of Economics and Finance, Lang School of Business, University of Guelph, ON, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rufaro 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