What specialist should an adult patient with a new diagnosis of pulmonary embolism and possible underlying conditions like cancer or heart disease follow up with?

Follow-Up Specialist for New Pulmonary Embolism Diagnosis

An integrated care model involving hospital specialists (cardiology or pulmonary medicine), appropriately qualified nurses, and primary care physicians is recommended to ensure optimal transition from hospital to community care after acute PE. 1

Recommended Follow-Up Structure

Routine Clinical Evaluation at 3-6 Months

• All patients with PE require mandatory routine clinical evaluation 3-6 months after the acute episode (Class I recommendation, Level B evidence). 1 This is not optional—it should be standard practice for every PE patient.

• This follow-up should assess for:

  • Persistent or new-onset dyspnea or functional limitation 1
  • Signs of VTE recurrence 1
  • Occult malignancy (particularly in unprovoked PE) 1
  • Bleeding complications from anticoagulation 1
  • Decision on extension of anticoagulant therapy 1

Specialist Involvement Based on Clinical Context

For patients with underlying cardiac disease or heart failure:

• Cardiology follow-up is appropriate, as these patients have 2.7 times higher risk of death within one year. 2 Cardiologists can assess right ventricular function and manage cardiac comorbidities that significantly impact prognosis.

For patients with cancer:

• Oncology should remain the primary specialist, with coordination for anticoagulation management, as cancer patients have 3.8 times higher risk of death within one year and PE is fatal in up to 14% of cancer patients. 3, 2

For patients with chronic lung disease:

• Pulmonary medicine follow-up is indicated, as these patients have 2.2 times higher risk of death within one year. 2

For uncomplicated PE without significant comorbidities:

• Primary care physicians can manage follow-up within an integrated care model, with specialist consultation available as needed. 1

Specialized Referral Pathways

Referral to Pulmonary Hypertension/CTEPH Expert Center

• Mandatory referral (Class I recommendation) if ventilation-perfusion scan shows mismatched perfusion defects. 1

• Consider referral (Class IIa recommendation) for patients with persistent dyspnea or exercise limitation after PE. 1

• May consider referral (Class IIb recommendation) even in asymptomatic patients with risk factors for chronic thromboembolic pulmonary hypertension (CTEPH), as approximately 1.5% of patients develop CTEPH, typically within 24 months. 1

Nurse-Led Care Models

• Appropriately qualified nurses should be integrated into the follow-up structure to screen for signs and symptoms of VTE recurrence, assess medication adherence, and provide patient education. 1 This model has proven effective in similar cardiovascular conditions and ensures continuity of care.

Critical Pitfall to Avoid

Never allow PE patients to be lost to follow-up. 1 The lifelong risk of VTE recurrence exists for all patients except those with acute PE provoked by a strong transient/reversible risk factor. 1 Most deaths after PE are due to underlying diseases (cancer 34.7%, infection 22.1%, cardiac disease 16.8%) rather than recurrent PE itself. 2 This underscores why integrated care addressing comorbidities is essential, not just anticoagulation management.