Dyspnea after a first episode of pulmonary embolism: prevalence, predictors and long-term associations with health-related quality of life.

INTRODUCTION

The predictors and consequences of dyspnea after pulmonary embolism (PE) are only rarely investigated. The present study aimed to characterize dyspnea and its associated factors in patients with incident PE up to 2 years after hospital discharge.

METHODS

Data from the German "Lungenembolie Augsburg (LEA)" cohort study were used. Baseline characteristics of adult patients with a first episode of acute PE were collected during hospital stay. Participants completed postal questionnaires 3, 6, 12, and 24 months after their PE. Dyspnea was assessed using the Chronic Respiratory Questionnaire (CRQ) and the Pulmonary Embolism Quality of Life Questionnaire (PEmb-QoL) was used to measure health-related quality of life (HRQOL). Linear mixed models were used to determine the variables associated with dyspnea.

RESULTS

Out of 503 patients (55% male, mean age 62.8 ± 14.6 years), 45%-64% of the participants had dyspnea at any time point. No significant change of dyspnea over time was found. Body mass index (estimate -0.04, 95% CI -0.06 to -0.02,  = 0.0002), symptoms of depression (estimate -0.11, 95% CI -0.15 to -0.07,  < 0.0001), symptoms of anxiety (estimate -0.08, 95% CI -0.11 to -0.04,  < 0.001), and FEV values (estimate 0.35, 95% CI 0.10-0.61,  = 0.0060) were significantly associated with the CRQ dyspnea score. Furthermore, dyspnea had significant and strong adverse associations with all subscales of the PEmb-QOL ( < 0.0001).

DISCUSSION

Dyspnea is a common and persisting complaint after PE. Symptoms of depression and anxiety are strongly related with dyspnea and dyspnea is significantly associated with impaired HRQOL.