Hestia Criteria Calculator for Outpatient Pulmonary Embolism Treatment

The original 11 Hestia criteria and source definitions

Ten clinical criteria use an externally established Yes/No assessment. Only the renal criterion is derived here from a numeric value. The original definitions and footnotes are retained, also reproduced in HOME-PE Table 2. [1, 2]

1. Hemodynamically unstable?

   Source examples: systolic BP <100 mmHg together with heart rate >100/min, or a condition requiring ICU admission. The criterion is left to clinician/investigator discretion. Submit that determination; this page does not infer it from vital signs.

2. Thrombolysis or embolectomy necessary?

   Submit an already established clinical assessment of whether thrombolysis or embolectomy is necessary. This calculator does not make that treatment decision or broaden the original item to every catheter procedure.

3. Active bleeding or high risk of bleeding?

   Source examples: gastrointestinal bleeding in the preceding 14 days; recent stroke <4 weeks; recent operation <2 weeks; bleeding disorder; thrombocytopenia with platelet count <75 × 10^9/L; uncontrolled hypertension with SBP >180 mmHg or DBP >110 mmHg. Submit the full clinical assessment, not a substitute bleeding score.

4. More than 24 h of oxygen supply required to maintain oxygen saturation >90%?

   The source requires >24 h of oxygen supply to maintain saturation >90%. Current oxygen use or a single saturation reading is not this criterion; exactly 24 h is not more than 24 h.

5. PE diagnosed during anticoagulant treatment?

   Submit whether this PE was diagnosed during anticoagulant treatment. No inference is made from an INR, medication list or previous VTE.

6. Severe pain needing IV pain medication for more than 24 h?

   Severe pain requiring IV pain medication for >24 h is the source criterion. A pain score or opioid use alone does not establish it.

7. Medical or social reason for hospital treatment for more than 24 h?

   A medical or social reason for hospital treatment for >24 h; source examples include infection, malignancy or no support system. This needs a clinical/social assessment, not an automated checklist substitution.

8. Cockcroft–Gault creatinine clearance — mL/min

   Enter the Cockcroft–Gault creatinine-clearance result used for this Hestia assessment. The source exclusion is <30 mL/min; exactly 30 is absent. Do not substitute eGFR, CKD-EPI, cystatin-C eGFR or serum creatinine. Zero is a literal value, not missing.

9. Severe liver impairment?

   The original source leaves severe liver impairment to physician discretion. Do not infer it here from Child-Pugh, MELD, bilirubin, INR or AST/ALT.

10. Currently pregnant?

    Current pregnancy is an original Hestia exclusion and remains in the current guideline table. Postpartum status is not automatically substituted for pregnancy.

11. Documented history of heparin-induced thrombocytopenia?

    Use documented history of heparin-induced thrombocytopenia. Low platelets, prior heparin exposure, an allergy entry or a 4Ts score alone is not this historical criterion.

What did the original Hestia Study show?

In 2011, 581 consecutive acute-PE patients were screened; 338 met outpatient eligibility criteria and 41 were excluded for study reasons. The remaining 297 (51% of those screened) received outpatient treatment. These are historical cohort observations, not an individual prediction. [1]

HOME-PE: a negative rule is not automatic discharge

The 2021 randomized HOME-PE trial compared Hestia and sPESI strategies combined with physician decision-making. The per-protocol primary 30-day composite of recurrent VTE, major bleeding or all-cause death was 3.82% (34/891) with Hestia and 3.57% (32/896) with sPESI; the Hestia strategy met the trial’s non-inferiority criterion. These are strategy-level outcomes, not individual probabilities or outcomes confined to patients sent home. [2]

Home treatment occurred in 38.4% (378/984) of the Hestia arm and 36.6% (361/986) of the sPESI arm. Hestia itself was negative in 39.4% (388/984); a negative rule was overruled in 13/388 (3.4%), including 10 patient refusals and 3 anticoagulant contraindications. Physician judgment and patient preference remained consequential. [2]

Current 2026 AHA/ACC outpatient context

For acute PE diagnosed in a clinic or ED, current guidance considers use of a decision tool reasonable to identify outpatient suitability; options include Hestia, PESI and sPESI. Outpatient treatment is reasonable in selected AHA/ACC Category A/B patients when appropriate and aligned with patient goals. Immediate access to anticoagulant medication and rapid, reliable expert follow-up must be in place. [3]

A negative Hestia rule does not establish AHA Category A/B, absence of RV dysfunction or biomarker elevation, every treatment contraindication, treatment access, follow-up, patient agreement or social feasibility beyond the submitted criterion. This calculator neither derives an AHA category nor chooses medication, dose, thrombolysis, admission or discharge. [3]

The guideline has a separate published correction; no change to the Hestia criteria is attributed to that correction here. [4]

Hestia vs PESI, sPESI, Bova and diagnostic PE tools

Hestia directly checks outpatient-treatment exclusions. PESI/sPESI are short-term mortality-oriented prognostic models and are alternative decision-tool options within current outpatient pathways. Bova stratifies complications in normotensive confirmed PE using SBP, pulse, troponin and RV dysfunction. Bova Stage I does not imply Hestia Negative, and Hestia Negative does not imply Bova Stage I. [2, 3]

Wells PE, PERC and YEARS address suspected PE before diagnosis: pretest probability, conditional rule-out, and criteria plus D-dimer, respectively. Hestia starts after diagnosis. CPES is another separate model. None is calculated or cross-converted here. [3]