Quality of life and functional limitations after pulmonary embolism and its prognostic relevance

Abstract

BackgroundWhile the importance of patients’ quality of life (QoL) in chronic cardiac or pulmonary disease is uncontroversial, the burden of an acute pulmonary embolism (PE) on QoL has received little attention thus far.ObjectivesWe aimed to validate the German PEmb‐QoL questionnaire, identify associations between QoL and clinical/functional parameters, and investigate the prognostic relevance of QoL for long‐term survival in survivors of an acute PE episode.Patients/MethodsPatients were invited for a clinical follow‐up visit including assessment of QoL using the German PEmb‐QoL questionnaire 6 months after an objectively confirmed PE at a single center. Internal consistency reliability, construct‐related validity, and regressions between PEmb‐QoL and clinical patient‐characteristics were assessed using standard scale construction techniques.ResultsOverall, 101 patients [median age, 69 ([interquartile range] IQR 57‐75) years; women, 48.5%] were examined 208 (IQR 185‐242) days after PE. Internal consistency reliability and construct‐related validity of the PEmb‐QoL questionnaire were acceptable. As many as 47.0% of patients reported dyspnea, 27.5% had right ventricular (RV) dysfunction on transthoracic echocardiography (TTE), and 25.3% were diagnosed with post‐PE impairment (PPEI) at 6‐month follow‐up. Furthermore, 15.9% of patients were diagnosed with depression 6 months after an acute PE. The QoL was affected by dyspnea, preexisting pulmonary disease, and PPEI, and a reduced QoL was associated with an increased risk for long‐term mortality after an observation period of 3.6 years.ConclusionsThe German PEmb‐QoL questionnaire is a reliable instrument for assessing QoL 6 months after PE. The QoL was affected by dyspnea, preexisting pulmonary disease, and PPEI and was associated with long‐term mortality.

Venous thromboembolism after lower extremity orthopedic surgery: A population‐based nationwide cohort study

“…Venous thromboembolism (VTE) is a collective term encompassing deep vein thrombosis and pulmonary embolism and a well-known complication to orthopedic surgery affecting both short and long-term mortality and quality of life. [1][2][3] More than 700 000 Europeans develop a VTE each year, and another 370 000 deaths annually are attributed to VTE, with only a minor fraction of the patients being diagnosed with and treated for VTE antemortem. 4 More than 60% of all VTEs are associated with hospitalization and occur after discharge from the hospital.…”

“…Orthopedic surgical procedures are some of the most commonly provided services in the health care systems worldwide. Venous thromboembolism (VTE) is a collective term encompassing deep vein thrombosis and pulmonary embolism and a well‐known complication to orthopedic surgery affecting both short and long‐term mortality and quality of life 1‐3 . More than 700 000 Europeans develop a VTE each year, and another 370 000 deaths annually are attributed to VTE, with only a minor fraction of the patients being diagnosed with and treated for VTE antemortem 4 .…”

Bilateral pulmonary embolism while receiving tranexamic acid: a case report

“…Our patient experienced some functional limitations and decreased quality of life with delayed PE diagnosis. She would have continued taking TXA without caution and could have been at risk of developing more serious PE complications, such as chronic thromboembolic pulmonary hypertension, life-threatening acute right (heart) ventricular failure, pulmonary infarction, and cardiac arrest, among other problems [ 22 – 24 ]. Worse still, this woman could have been sent home after the third hospital visit with a false reassurance that her symptoms were likely musculoskeletal pain following the absence of significant risk factors for PE.…”

Diagnosis of chronic thromboembolic pulmonary hypertension after acute pulmonary embolism

“…Natural course of symptom recovery after acute PE Several cohort studies have shown that approximately 40-50% of patients reports persistent or worsening dyspnoea and functional limitations in the course of adequately treated acute PE, a prevalence of dyspnoea that is higher than expected in the general population and greatly affects quality of life. [15][16][17][18][19][20][21][22][23][24] In these studies, dyspnoea was defined as symptoms corresponding to a New York Heart Association (NYHA) functional class of ≥II, with 10-20% of patients categorized as NYHA functional class III or IV. [15][16][17][18] Notably, symptoms of dyspnoea and results of a 6-minute walking test 5 improve in the majority of patients in the first year months following an acute PE diagnosis, although most improvement occurs in the first three months.…”