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 (article from Montreal Canada)

Am J Med. 2017 Apr 8. pii: S0002-9343(17)30361-3. doi:
10.1016/j.amjmed.2017.03.033. [Epub ahead of print]

BACKGROUND: 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: 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 SF-36 and PEmb-QOL measures), dyspnea (by the University of
California San Diego Shortness of Breath Questionnaire (SOBQ)) and six-minute
walk distance at Baseline, 1, 3, 6, and 12 months after acute pulmonary embolism.
CT 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 six-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
out-patients. 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 six-minute walk distance improved by 40 m. Independent
predictors of reduced improvement over time were female sex, higher BMI 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 CT 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 BMI and exercise limitation on 1- month cardiopulmonary exercise test. Our results provide new information on patient-relevant prognosis after pulmonary embolism.