Consistent with AT9, we suggest that patients who satisfy all of the following criteria are suitable for treatment of acute PE out of the hospital: (1) clinically stable with good cardiopulmonary reserve; (2) no contraindications such as recent bleeding, severe renal or liver disease, or severe thrombocytopenia ); (3) expected to be compliant with treatment; and (4) the patient feels well enough to be treated at home. Clinical decision rules such as the Pulmonary Embolism Severity Index (PESI), either the original form with score <85 or the simpli ed form with score of 0, can help to identify low-risk patients who are suitable for treatment at home.126-131 However, we consider clinical prediction rules as aids to decision- making and do not require patients to have a prede ned score (eg, low-risk PESI score) to be considered for treatment at home. Similarly, although we do not suggest the need for routine assessment in patients with acute PE, we agree that the presence of right ventricular dysfunction or increased cardiac biomarker levels should discourage treatment out of the hospital.130,132-138 The quality of the evidence for treatment of acute PE at home remains moderate because of marked imprecision. The updated recommendation has been modi ed to state that appropriately selected patients may be treated entirely at home, rather than just be discharged early. *20. In patients with low-risk PE and whose home circumstances are adequate, we suggest treatment at home or early discharge over standard discharge (eg, after the rst 5 days of treatment) (Grade 2B). 