![Spider graph to depict the effect size values on changes in health-related quality of life and its subscales and dyspnea scores from baseline to 1 year, according to percent-predicted VO2 peak 80% at 1 year. Concentric circles around the central target represent effect size in mean changes in scores from baseline to 1 year.4 Health-related quality of life and dyspnea scores improved more in patients with percent-predicted VO2 peak >80% at 1 year (distance between central point [0.0] and blue line) compared with patients with percent-predicted VO2 peak <80% at 1 year (distance between central point [0.0] and red line). PEmb-QoL = pulmonary embolism quality of life questionnaire; SF-36 = Short-Form Health Survey-36; SOBQ = University of California at San Diego Shortness of Breath Questionnaire.](https://i0.wp.com/amjmed.org/wp-content/uploads/2017/12/fx2.jpg?ssl=1)
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.
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-Susan R. Kahn, MD, MSc, Arash Akaberi, MSc, John T. Granton, MD, David R. Anderson, MD, Philip S. Wells, MD, MSc, Marc A. Rodger, MD, MSc, Susan Solymoss, MD, Michael J. Kovacs, MD, Lawrence Rudski, MD, Avi Shimony, MD, Carole Dennie, MD, Chris Rush, MD, Paul Hernandez, MD, Shawn D. Aaron, MD, Andrew M. Hirsch, MD
This article originally appeared in the August 2017 issue of The American Journal of Medicine.
