Melanie Cole, MS (Host): Welcome to Better Edge, a Northwestern Medicine Podcast for physicians. I'm Melanie Cole. And today, we're highlighting the Canning Thoracic Institute's New Blood Clot Clinic. Joining me is Dr. Maanasi Samant. She's an Assistant Professor of Pulmonary and Critical care at Northwestern Medicine's Canning Thoracic Institute.

Dr. Samant, welcome. I'm so glad you could join us today. As we get started, tell us a little bit about how this came about, blood clot clinic. What motivated the creation of this?

Dr. Maanasi Samant: Thank you so much for having me. I'm really happy to be here and excited to talk to you guys about this new clinic. So when we think about PE survivorship, it's really not just one static, singular outcome. Patients who have been diagnosed with a PE, about 50% of the time at the one-year mark report persistent symptoms of shortness of breath, functional limitations, and inability to sort of provide for themselves, provide for their family members.

And as you can imagine, this has the potential to have significant societal-level outcomes. It could impact the ability of patients to return to work. It impacts potentially healthcare utilization. And along the spectrum, not only are we sort of helping patients recover and get over the PE in general, but we're also screening for long-term complications related to the blood clot, like chronic thromboembolic pulmonary hypertension. So, the blood clot clinic is really a nice comprehensive tool that we have to help patients as they recover from their PE.

Melanie Cole, MS: That's so important. And Dr. Samant, for referring clinicians, what are some of the indicators that a patient recovering from PE may need some specialized followup? You mentioned CTEPH complications that we're keeping our eyes on. Tell us a little bit about what are the key indicators for this particular clinic?

Dr. Maanasi Samant: Yeah. So, you know, I think that anyone who has been hospitalized for a pulmonary embolism warrants a referral to our clot clinic. Anyone who's had a PE and has persistent symptoms, even a few months after their initial event, warrants a referral to the blood clot clinic. We're not only screening for these long-term complications like CTEPH, but we're also helping patients along this process of recovery. We want to be a source of support for Patients because, you know, not only are they struggling with persistent shortness of breath, but they also are struggling with a lot of psychological impact or psychological sequelae from their PE.

There's this entity known as post-thrombotic panic syndrome, and patients struggle with sort of PTSD-like symptoms after they've had a PE. And so, this allows us an opportunity to not only screen for these long-term complications, but also to really support our patients as they're recovering.

Melanie Cole, MS: Well, that's such an important point that you mentioned. Because quality of life and certainly fear of more or another embolism, this has really got to affect the psychosocial aspect for the patient. So along those lines, then, Dr. Samant, walk us through that pathway through the clinic's care pathway as we think of, you know, for referring physicians, ongoing monitoring, regular check-ins, access to advanced diagnostics, all of these are so important when we think of supporting that recovery.

Dr. Maanasi Samant: Absolutely. So currently, the way our process works is that anyone who's been hospitalized for a pulmonary embolism gets a referral to our clot clinic at time of discharge. They automatically get a one-month and three-month appointment set up at the time of discharge. And we also take referrals from the outpatient side as well. So, anyone who a provider is concerned for can refer to our clot clinic. And so once that referral is in, they see me or one of my partners. We also have two nurse practitioners who work with us. And at each visit, we screen patients for these persistent symptoms. We ensure adequate access to anticoagulation and provide just general counseling on how to recover from a PE. Frequently, we see patients who've had a PE who are scared to exercise, scared to get back into sort of their daily routine.

And, you know, oftentimes we find that and previous studies have shown that if patients who are about six months to a year out from their initial event suffer from a lot of deconditioning. So, sort of intervening early and getting face time with patients early to reassure them that it's okay to get back into things, it's okay to start exercising, provided, you know, everything else is okay, I think is really, really important. So, we screen for symptoms. We provide general counseling, ensure adequate access to anticoagulation. And then, as patients progress, if they're having persistent symptoms at their three-month visit, at their six-month visit or even a year out, we start to talk about, "Okay, well, what else could be going on?"

We obviously screen for complications like chronic thromboembolic pulmonary hypertension. But beyond that, there's this entity known as the post PE syndrome, which encompasses CTEPH as well as anything that's causing functional limitations in our patients. So, simply deconditioning, diastolic dysfunction, or maybe they just have chronic clot that doesn't result in CTEPH. So, we sort of screen for all of those things, employ the appropriate diagnostics to try to figure out why our patients are limited, and figure out how best to help them.

Melanie Cole, MS: So, that's so important. And along those lines, then I want to expand for a minute on that, when we think of the team approach and the multidisciplinary approach that's so important for these patients, and you mentioned deconditioning and fear and all of these things. Tell us about your team, Dr. Samant, and how you're well-positioned to help them, whether it's with exercise, so that they know that they're safe and that they're monitored, or whether it's with counseling, as you said, or group support, whatever is involved. Tell us a little bit for referring physicians so they know how well taken care of their patients are.

Dr. Maanasi Samant: Absolutely. So, our team involves me, two other pulmonary critical care physicians, and one cardiologist. We also work very closely with our hematology colleagues. And then, we have two advanced practice providers that are in our clot clinic as well. And so, we have the ability to plug patients into the appropriate referral pathways as needed. And what's really, I think, unique about Northwestern's Clot Clinic is that as we're seeing these patients who are recovering from a PE, if we go down the diagnostic pathway of potential CTEPH and end up diagnosing CTEPH, all of our providers are CTEPH providers as well. So, we don't have to go through that additional hurdle of referral to a specialized CTEPH clinic, which has the potential to delay care.

So, I think that's really unique and an excellent resource for our patients. We know that studies have shown that patients who are followed in a PE clinic, if they end up getting diagnosed with CTEPH, their diagnosis is made earlier, their disease is not as severe, and they get that advanced treatment option much sooner than those who are just coming from the community and end up being referred to a CTEPH center. So, our hope is to allow for earlier diagnosis treatment of potential CTEPH in addition to helping our patients recover in general from PE.

Melanie Cole, MS: So, that's really a comprehensive approach that you've described here, Dr. Samant. And tell us a little bit about research or any innovative therapies that are currently available through the clinic, things that you're looking towards in the future and, for referring physicians, how you would like them to identify patients that might benefit from all of these therapies.

Dr. Maanasi Samant: Yeah. So currently, we are collecting data on our PE survivors that come through our clinic in the hopes of expanding our research database and potentially collaborating with industry and medical companies in the future. We hope as our clinic volume grows that we'll be able to partner with pulmonary rehab or physical therapy and provide these resources to our patients as our clinic continues to grow.

For referring providers, I would say that anyone whom you're concerned about who's had a PE, totally reasonable referral to our clot clinic. Anyone who's struggling with persistent symptoms after they've been diagnosed with a PE and are on anticoagulation absolutely should be referred to our clot clinic. Anyone whom you see, you know, is going to the emergency room or urgent care after their PE diagnosis for persistent symptoms, please send to a clot clinic. Anyone who's been hospitalized for their PE should absolutely come to us.

You know, I think, as I mentioned earlier, this is an opportunity not only for us to screen for long-term PE-related complications, but also to help allay those fears that patients frequently have, help just general recovery and provide general counseling for patients and make sure that they're tolerating anticoagulation and just recovering as a whole human from their PE.

Melanie Cole, MS: That was beautifully said, Dr. Samant. I love that you said that. Because it is really, truly about the whole human. It's not just their PE. And while that may be what goes through their mind so many hours of the day, this is something that is really important to them. And that quality of life that you mentioned, I think, is just such a great thing for you to highlight for referring physicians. So, I'd love you to give us a summary, kind of the key takeaways, what you would like referring physicians and other physicians to know about the new Blood Clot Clinic at Canning Thoracic Institute at Northwestern Medicine, and why this comprehensive care is so important for these patients' quality of life.

Dr. Maanasi Samant: Yeah. So, PE survivorship is not linear. Patients recover at different rates. And 50% of the time, they have persistent symptoms that can be, frankly, quite debilitating. And a small percentage of those patients can go on to develop chronic complications like CTEPH. So, referring patients to our clot clinic is a means for us to not only screen for those long-term complications, but also to help patients through this process, provide counseling, provide resources, and employ appropriate diagnostics and management strategies to help patients as they recover from their PE.

Melanie Cole, MS: This is great information. Thank you so much for telling us about the clinic today and sharing your incredible expertise. To refer your patient or for more information, please visit our website at breakthroughsforphysicians.nm.org/pulmonary to get connected with one of our providers. That concludes this episode of Better Edge, a Northwestern Medicine Podcast for physicians. I'm Melanie Cole.

Dr. Maanasi Samant: Thank you.