Key result
Subsequent rehospitalization (effect size 11.29; 95% CI 6.68-15.89), COPD, and longer hospital stay independently predicted worse quality of life 1 month after acute pulmonary embolism.
Why the study?
The authors aimed to determine whether any clinical or pathophysiologic features of PE were associated with worse PEmb-QoL scores 1 month after PE.
Cohort (n=788)
Yes
Mean Difference: 11.29 (95% CI 6.68–15.89)
Acute clinical deterioration, right ventricular dysfunction, and PE severity do not predict quality of life at 1 month post-PE, whereas rehospitalization, COPD, and longer hospital stay are independent predictors of worse QoL.
Rehospitalization and COPD were associated with worse post-PE QoL; leaves open whether targeted interventions improve outcomes.
OBJECTIVE: The Pulmonary Embolism Quality-of-Life (PEmb-QoL) questionnaire assesses quality of life (QoL) after pulmonary embolism (PE). We aimed to determine whether any clinical or pathophysiologic features of PE were associated with worse PEmb-QoL scores 1 month after PE. METHODS: In this prospective multicenter registry, we conducted PEmb-QoL questionnaires. We determined differences in QoL domain scores for four primary variables: clinical deterioration (death, cardiac arrest, respiratory failure, hypotension requiring fluid bolus, catecholamine support, or new dysrhythmia), right ventricular dysfunction (RVD), PE risk stratification, and subsequent rehospitalization. For overall QoL score, we fit a multivariable regression model that included these four primary variables as independent variables. RESULTS: Of 788 PE patients participating in QoL assessments, 156 (19.8%) had a clinical deterioration event, 236 (30.7%) had RVD of which 38 (16.1%) had escalated interventions. For those without and with clinical deterioration, social limitations had mean (±SD) scores of 2.07 (±1.27) and 2.36 (±1.47), respectively (p = 0.027). For intensity of complaints, mean (±SD) scores for patients without RVD (4.32 ± 2.69) were significantly higher than for those with RVD with or without reperfusion interventions (3.82 ± 1.81 and 3.83 ± 2.11, respectively; p = 0.043). There were no domain score differences between PE risk stratification groups. All domain scores were worse for patients with rehospitalization versus without. By multivariable analysis, worse total PEmb-QoL scores with effect sizes were subsequent rehospitalization 11.29 (6.68-15.89), chronic obstructive pulmonary disease (COPD) 8.17 (3.91-12.43), and longer index hospital length of stay 0.06 (0.03-0.08). CONCLUSIONS: Acute clinical deterioration, RVD, and PE severity were not predictors of QoL at 1 month post-PE. Independent predictors of worsened QoL were rehospitalization, COPD, and index hospital length of stay.
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Weekes et al. (2023) conducted a cohort in Acute pulmonary embolism (n=788). Clinical deterioration, right ventricular dysfunction, PE risk stratification, and rehospitalization vs. Patients without these features was evaluated on Total PEmb-QoL score at 1 month (Effect size 11.29, 95% CI 6.68-15.89). Subsequent rehospitalization (effect size 11.29; 95% CI 6.68-15.89), COPD, and longer hospital stay independently predicted worse quality of life 1 month after acute pulmonary embolism.
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