Health-related quality of life after pulmonary embolism: a cross-sectional study

Mazdak Tavoly, Kristin Kornelia Utne, Lars-Petter Jelsness-Jørgensen, Hilde Skuterud Wik, Frederikus A Klok, Per Morten Sandset, Waleed Ghanima, Mazdak Tavoly, Kristin Kornelia Utne, Lars-Petter Jelsness-Jørgensen, Hilde Skuterud Wik, Frederikus A Klok, Per Morten Sandset, Waleed Ghanima

Abstract

Objectives: The psychological effects of acute pulmonary embolism (PE) have scarcely been studied. The aims of this study were to evaluate health-related quality of life (HRQoL) in patients with a history of PE compared with that of the general population and buddy controls, and to explore factors that may predict impaired HRQoL.

Design: Cross-sectional.

Setting: Haematology and thrombosis unit in Fredrikstad, Norway.

Participants: 213 consecutive patients treated for PE were identified from hospital registries. Eligible patients were scheduled for a single study visit, including a functional capacity test (6 min walking test). HRQoL was assessed using the EuroQol 5D dimensions 3-level (EQ-5D-3L) questionnaire, of which the results were compared with Danish population norms and age-matched and sex-matched buddy controls. The buddy controls were recruited by asking every patient to hand over the EQ-5D questionnaire to 2 age-matched and sex-matched friends or relatives. Multivariable regression analyses were used to examine possible determinants of reduced HRQoL.

Results: Mean age was 61 years (SD 15), 117 (55%) were males, and median time since diagnosis was 3.8 years (range 0.3-9.5). Mean EuroQol visual analogue scale (EQ VAS) was 67 in PE as compared with 81 in the general population (p<0.005) and corresponding EQ-5D index values were 0.80 and 0.86 (p<0.005). Patients reported more problems in all 5 EQ-5D compared with both the buddy controls and the general population, p<0.05. Shorter 6 min walking distance (β=0.09, p<0.005) and patient-reported dyspnoea (β=11.27, p<0.005) were independent predictors of lower EQ VAS scores.

Conclusions: Our findings show that patients with a history of PE have impaired HRQoL when compared with the general population and buddy controls. Reduced functional capacity and persistent dyspnoea were the main predictors of this impairment.

Keywords: cross-sectional; exercise tolerance; pulmonary embolism; quality of life.

Conflict of interest statement

WG reports grants and lecture honoraria from Bayer, Novartis and Roche and lecture and advisory board honoraria from Pfizer, Bayer and from Boehringer Ingelheim. LPJ-J reports unrestricted grants from Ferring pharmaceuticals and Tillots pharma, and personal fees from Abbvie.

Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Figures

Figure 1
Figure 1
Study flow chart. 6MWT, 6 min walking test; EQ-5D-3L, EuroQol five-dimension three-level; HRQoL, health related quality of life; PE, pulmonary embolism; QoL, quality of life.
Figure 2
Figure 2
Proportion of patients, Danish population and buddy controls reporting problems stratified by EQ-5D dimensions. EQ-5D, EuroQol five-dimension.

References

    1. Kahn SR. The post-thrombotic syndrome: progress and pitfalls. Br J Haematol 2006;134:357–65. 10.1111/j.1365-2141.2006.06200.x
    1. Fedullo PF, Auger WR, Kerr KM et al. . Chronic thromboembolic pulmonary hypertension. N Engl J Med 2001;345:1465–72. 10.1056/NEJMra010902
    1. Pengo V, Lensing AWA, Prins MH et al. . Incidence of chronic thromboembolic pulmonary hypertension after pulmonary embolism. N Engl J Med 2004;350:2257–64. 10.1056/NEJMoa032274
    1. Klok FA, Tijmensen JE, Haeck MLA et al. . Persistent dyspnea complaints at long-term follow-up after an episode of acute pulmonary embolism: results of a questionnaire. Eur J Intern Med 2008;19:625–9. 10.1016/j.ejim.2008.02.006
    1. Klok FA, Cohn DM, Middeldorp S et al. . Quality of life after pulmonary embolism: validation of the PEmb-QoL Questionnaire. J Thromb Haemost 2010;8:523–32. 10.1111/j.1538-7836.2009.03726.x
    1. Klok FA, van Kralingen KW, van Dijk APJ et al. . Quality of life in long-term survivors of acute pulmonary embolism. Chest 2010;138:1432–40. 10.1378/chest.09-2482
    1. van Es J, den Exter PL et al. . Quality of life after pulmonary embolism as assessed with SF-36 and PEmb-QoL. Thromb Res 2013;132:500–5. 10.1016/j.thromres.2013.06.016
    1. Noble S, Lewis R, Whithers J et al. . Long-term psychological consequences of symptomatic pulmonary embolism: a qualitative study. BMJ Open 2014;4:e004561 10.1136/bmjopen-2013-004561
    1. Bennett P, Patterson K, Noble S. Predicting post-traumatic stress and health anxiety following a venous thrombotic embolism. J Health Psychol 2016;21:863–71. 10.1177/1359105314540965
    1. Kline JA, Steuerwald MT, Marchick MR et al. . Prospective evaluation of right ventricular function and functional status 6 months after acute submassive pulmonary embolism. Chest 2009;136:1202–10. 10.1378/chest.08-2988
    1. Klok FA, van der Hulle T, Exter den PL et al. . The post-PE syndrome: a new concept for chronic complications of pulmonary embolism. Blood Rev 2014;28:221–6. 10.1016/j.blre.2014.07.003
    1. Højen AA, Gorst-Rasmussen A, Lip GYH et al. . Use of psychotropic drugs following venous thromboembolism in youth. A nationwide cohort study. Thromb Res 2015;135:643–7. 10.1016/j.thromres.2015.01.024
    1. Rasekaba T, Lee AL, Naughton MT et al. . The six-minute walk test: a useful metric for the cardiopulmonary patient. Intern Med J 2009;39:495–501. 10.1111/j.1445-5994.2008.01880.x
    1. ATS Committee on Proficiency Standards for Clinical Pulmonary Function Laboratories. ATS statement: guidelines for the six-minute walk test. Am J Respir Crit Care Med 2002;166:111–17. 10.1164/ajrccm.166.1.at1102
    1. Enright PL, Sherrill DL. Reference equations for the six-minute walk in healthy adults. Am J Respir Crit Care Med 1998;158:1384–7. 10.1164/ajrccm.158.5.9710086
    1. EuroQol Group. EuroQol-a new facility for the measurement of health-related quality of life. Health Policy 1990;16:199–208.
    1. Brooks R. EuroQol: the current state of play. Health Policy 1996;37:53–72.
    1. Wittrup-Jensen KU, Lauridsen J, Gudex C et al. . Generation of a Danish TTO value set for EQ-5D health states. Scand J Public Health 2009;37:459–66. 10.1177/1403494809105287
    1. Ghanima W, Abdelnoor M, Holmen LO et al. . The association between the proximal extension of the clot and the severity of pulmonary embolism (PE): a proposal for a new radiological score for PE. J Intern Med 2007;261:74–81. 10.1111/j.1365-2796.2006.01733.x
    1. Hjermstad MJ, Fayers PM, Bjordal K et al. . Using reference data on quality of life—the importance of adjusting for age and gender, exemplified by the EORTC QLQ-C30 (+ 3). Eur J Cancer 1998;34:1381–9.
    1. Simons CL, Rivero-Arias O, Yu LM et al. . Multiple imputation to deal with missing EQ-5D-3L data: Should we impute individual domains or the actual index? Qual Life Res 2015;24:805–15. 10.1007/s11136-014-0837-y
    1. Jaeschke R, Singer J, Guyatt GH. Measurement of health status. Ascertaining the minimal clinically important difference. Control Clin Trials 1989;10:407–15.
    1. Marra CA, Woolcott JC, Kopec JA et al. . A comparison of generic, indirect utility measures (the HUI2, HUI3, SF-6D, and the EQ-5D) and disease-specific instruments (the RAQoL and the HAQ) in rheumatoid arthritis. Soc Sci Med 2005;60:1571–82. 10.1016/j.socscimed.2004.08.034
    1. Walters SJ, Brazier JE. Comparison of the minimally important difference for two health state utility measures: EQ-5D and SF-6D. Qual Life Res 2005;14:1523–32.
    1. Luo N, Johnson J, Coons SJ. Using instrument-defined health state transitions to estimate minimally important differences for four preference-based health-related quality of life instruments. Med Care 2010;48:365–71.
    1. de Vet HCW, Ostelo RWJG, Terwee CB et al. . Minimally important change determined by a visual method integrating an anchor-based and a distribution-based approach. Qual Life Res 2007;16:131–42. 10.1007/s11136-006-9109-9
    1. Ehlken N, Lichtblau M, Klose H et al. . Exercise training improves peak oxygen consumption and haemodynamics in patients with severe pulmonary arterial hypertension and inoperable chronic thrombo-embolic pulmonary hypertension: a prospective, randomized, controlled trial. Eur Heart J 2016;37:35–44. 10.1093/eurheartj/ehv337
    1. Nagel C, Prange F, Guth S et al. . Exercise training improves exercise capacity and quality of life in patients with inoperable or residual chronic thromboembolic pulmonary hypertension. PLoS ONE 2012;7:e41603–9. 10.1371/journal.pone.0041603
    1. Rochester CL, Fairburn C, Crouch RH. Pulmonary rehabilitation for respiratory disorders other than chronic obstructive pulmonary disease. Clin Chest Med 2014;35:369–89. 10.1016/j.ccm.2014.02.016
    1. Yuan P, Yuan XT, Sun XY et al. . Exercise training for pulmonary hypertension: a systematic review and meta-analysis. Int J Cardiol 2015;178:142–6. 10.1016/j.ijcard.2014.10.161
    1. Lakoski SG, Savage PD, Berkman AM et al. . The safety and efficacy of early-initiation exercise training after acute venous thromboembolism: a randomized clinical trial. J Thromb Haemost 2015;13:1238–44. 10.1111/jth.12989
    1. Stevinson BG, Hernandez-Nino J, Rose G et al. . Echocardiographic and functional cardiopulmonary problems 6 months after first-time pulmonary embolism in previously healthy patients. Eur Heart J 2007;28:2517–24. 10.1093/eurheartj/ehm295
    1. Chow V, Ng ACC, Seccombe L et al. . Impaired 6-min walk test, heart rate recovery and cardiac function post pulmonary embolism in long-term survivors. Respir Med 2014;108:1556–65. 10.1016/j.rmed.2014.08.002
    1. Klok FA, van Kralingen KW, van Dijk APJ et al. . Prevalence and potential determinants of exertional dyspnea after acute pulmonary embolism. Respir Med 2010;104:1744–9. 10.1016/j.rmed.2010.06.006
    1. Grandy S, Fox KM. EQ-5D visual analog scale and utility index values in individuals with diabetes and at risk for diabetes: findings from the Study to Help Improve Early evaluation and management of risk factors Leading to Diabetes (SHIELD). Health Qual Life Outcomes 2008;6:18 10.1186/1477-7525-6-18
    1. Stewart LK, Peitz GW, Nordenholz KE et al. . Contribution of fibrinolysis to the physical component summary of the SF-36 after acute submassive pulmonary embolism. J Thromb Thrombolysis 2015;40:161–6. 10.1007/s11239-014-1155-5
    1. Sanchez O, Helley D, Couchon S et al. . Perfusion defects after pulmonary embolism: risk factors and clinical significance. J Thromb Haemost 2010;8:1248–55. 10.1111/j.1538-7836.2010.03844.x

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