Pulmonary embolism
Hestia Criteria
Eleven bedside questions from the Hestia study (Zondag 2011). If every answer is "no", the patient can be treated at home or discharged early (3-month recurrence 2%, major bleeding 0.7%, death 1%). In HOME-PE, Hestia was as safe as sPESI for selecting outpatient treatment.
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Criteria
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Total score
0
Hestia negative: eligible for home treatment
3-month VTE recurrence ≈ 2%, major bleeding ≈ 0.7%, death ≈ 1%
Decision guide
Early discharge or outpatient treatment with a DOAC (or LMWH) if proper follow-up can be arranged (ESC 2019 IIa; ACC/AHA 2026: Hestia, PESI or sPESI to select home treatment, Class 1). Confirm no RV dysfunction or troponin rise if checked (ESC intermediate-low → hospital).
Ranges: 0 Hestia negative: eligible for home treatment1–11 Hestia positive: treat in hospital
References
- Zondag W, et al. Outpatient treatment in patients with acute pulmonary embolism: the Hestia Study. J Thromb Haemost 2011;9:1500-1507.
- Roy PM, et al. Hestia criteria or simplified PESI to select patients with pulmonary embolism for outpatient treatment (HOME-PE): a randomised non-inferiority trial. Eur Heart J 2021;42:3146-3157.
- Konstantinides SV, et al. 2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism. Eur Heart J 2020;41:543-603.
- Creager MA, et al. 2026 AHA/ACC/ACCP/ACEP/CHEST/SCAI/SHM/SIR/SVM/SVN Guideline for the evaluation and management of acute pulmonary embolism in adults. Circulation 2026;153:e977-e1051.
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