Quality of Life, Dyspnea, and Functional Exercise Capacity Following a First Episode of Pulmonary Embolism: Results of the ELOPE Cohort Study.

Kahn SR; Akaberi A; Granton JT; Anderson DR; Wells PS; Rodger MA; Solymoss S; Kovacs MJ; Rudski L; Shimony A; Dennie C; Rush C; Hernandez P; Aaron SD; Hirsch AM,

The American Journal Of Medicine [Am J Med], ISSN: 1555-7162, 2017 Aug; Vol. 130 (8), pp.
990.e9-990.e21; Publisher: Excerpta Medica; PMID: 28400247;

We aimed to evaluate health-related quality of life (QOL), dyspnea, and
functional exercise capacity during the year following the diagnosis of
a first episode of pulmonary embolism.
Methods: This was a prospective
multicenter cohort study of 100 patients with acute pulmonary embolism
recruited at 5 Canadian hospitals from 2010-2013. We measured the
outcomes QOL (by Short-Form Health Survey-36 [SF-36] and Pulmonary
Embolism Quality of Life [PEmb-QoL] measures), dyspnea (by 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 pulmonary
angiography was performed at baseline, echocardiogram was performed
within 10 days, and cardiopulmonary exercise testing was performed at 1
and 12 months. Predictors of change in QOL, dyspnea, and 6-minute walk
distance were assessed by repeated-measures mixed-effects models
analysis.Results: Mean age was 50.0 years; 57% were male and 80% were
treated as outpatients. Mean scores for all outcomes improved during
1-year follow-up: from baseline to 12 months, mean SF-36 physical
component score improved by 8.8 points, SF-36 mental component score 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. Independent predictors of
reduced improvement over time were female sex, higher body mass index,
and percent-predicted VO2 peak <80% on 1 month cardiopulmonary exercise
test for all outcomes; prior lung disease and higher pulmonary artery
systolic pressure on 10-day echocardiogram for the outcomes SF-36
physical component score and dyspnea score; and higher main pulmonary
artery diameter on baseline computed tomography pulmonary angiography
for the outcome PEmb-QoL score.Conclusions: On average, QOL, dyspnea,
and walking distance improve during the year after pulmonary embolism.
However, a number of clinical and physiological predictors of reduced
improvement over time were identified, most notably female sex, higher
body mass index, and exercise limitation on 1-month cardiopulmonary
exercise test. Our results provide new information on patient-relevant
prognosis after pulmonary embolism.