QoL, dyspnoea, walking distance improve within a year after pulmonary embolism diagnosis
There is, on average, an improvement in dyspnoea, walking distance and quality of life (QoL) during the year after a first episode of pulmonary embolism, particularly during the first 3 months, according to a recent study. However, there are also several clinical and physiological predictors of attenuated improvement over time, such as female sex, higher body mass index (BMI) and exercise limitation on 1-month cardiopulmonary exercise test.
“Our study provides prognostic information on patient-important health outcomes after pulmonary embolism and highlights the need to include measurement of one or more functional outcomes in studies of interventions to treat pulmonary embolism,” researchers said.
In this prospective multicentre cohort study, researchers recruited 100 patients (mean age 50 years; 57 percent male; 80 percent treated as outpatients) with acute pulmonary embolism at five Canadian hospitals from 2010 to 2013.
They measured the outcomes QoL using the Short-Form Health Survey-36 (SF-36) and Pulmonary Embolism (PEmb)-QoL measures, dyspnoea using the University of California San Diego Shortness of Breath Questionnaire (SOBQ), and 6-minute walk distance at baseline and 1, 3, 6, and 12 months after acute pulmonary embolism.
Computed tomography (CT) pulmonary angiography was performed at baseline, echocardiogram within 10 days, and cardiopulmonary exercise testing at 1 and 12 months. Repeated-measures mixed-effects models analysis was used to assess the predictors of change in QoL, dyspnoea and 6-minute walk distance.
During a 1-year follow-up, mean scores for all outcomes improved from baseline to 12 months: mean SF-36 physical component score improved by 8.8 points; SF-36 mental component score improved by 5.3 points, PEmb-QoL by ‒32.1 points and SOBQ by ‒16.3 points; and 6-minute walk distance improved by 40 m. [Am J Med 2017;130:990.e9–990.e21]
Female sex, higher BMI and percent-predicted VO2 peak <80 percent on 1 month cardiopulmonary exercise test independently predicted reduced improvement over time for all outcomes. The independent predictors for the outcomes SF-36 physical component score and dyspnoea score were prior lung disease and higher pulmonary artery systolic pressure on 10-day echocardiogram; and higher main pulmonary artery diameter on baseline CT pulmonary angiography for the outcome PEmb-QoL score.
“In our study, women and those with higher BMI had less improvement in QoL, dyspnoea score and 6-minute walk distance from baseline for reasons that are unclear but merit further study, including whether weight reduction could have potential to enhance recovery after pulmonary embolism,” researchers said.
Exercise limitation on 1-month cardiopulmonary exercise test predicted worse functional outcome during follow-up, suggesting that identifying exercise-limited patients early after pulmonary embolism was of prognostic value. Moreover, exercise rehabilitation interventions early after pulmonary embolism may help improve long-term functional outcomes, according to researchers.
“Finally, we observed that evidence of higher values of pulmonary artery systolic pressure on baseline CT pulmonary angiography or echocardiogram predicted worse SF-36 Physical Component Summary score, PEmb-QoL and dyspnoea scores during follow-up, but higher CT [obstruction] index on baseline CT pulmonary angiography did not,” researchers said.
“The relationship between anatomic or physiological effects of pulmonary embolism and long-term functional outcome remains to be clarified, but our results suggest there could be an opportunity to use these imaging findings to help identify patients who might obtain long-term functional benefit from thrombolytic therapy for pulmonary embolism,” they added. [Vasc Med 2017;22:37–43]