title: Quality of Life, Dyspnea, and Functional Exercise Capacity Following a First Episode of Pulmonary Embolism: Results of the ELOPE Cohort Study.
abstract: 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.
  
  
  
  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.
  
  
  
  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 VO2peak <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.
  
  
  
  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.
authors.affiliation: Department of Medicine, Jewish General Hospital, Montreal, Quebec, Canada; Center for Clinical Epidemiology, Lady Davis Institute, Montreal, Quebec, Canada; Department of Medicine, McGill University, Montreal, Quebec, Canada. Electronic address: susan.kahn@mcgill.ca.
authors.forename: Susan R
authors.initials: SR
authors.lastname: Kahn
authors.affiliation: Center for Clinical Epidemiology, Lady Davis Institute, Montreal, Quebec, Canada.
authors.forename: Arash
authors.initials: A
authors.lastname: Akaberi
authors.affiliation: Division of Respirology, Department of Medicine, University of Toronto, Ontario, Canada.
authors.forename: John T
authors.initials: JT
authors.lastname: Granton
authors.affiliation: Department of Medicine, Dalhousie University, Halifax, NS, Canada.
authors.forename: David R
authors.initials: DR
authors.lastname: Anderson
authors.affiliation: Department of Medicine, University of Ottawa, and the Ottawa Hospital Research Institute, Ontario, Canada.
authors.forename: Philip S
authors.initials: PS
authors.lastname: Wells
authors.affiliation: Department of Medicine, University of Ottawa, and the Ottawa Hospital Research Institute, Ontario, Canada.
authors.forename: Marc A
authors.initials: MA
authors.lastname: Rodger
authors.affiliation: Department of Medicine, McGill University, Montreal, Quebec, Canada.
authors.forename: Susan
authors.initials: S
authors.lastname: Solymoss
authors.affiliation: Division of Hematology, Department of Medicine, Western University, London, Ontario, Canada.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Kovacs
authors.affiliation: Department of Medicine, Jewish General Hospital, Montreal, Quebec, Canada.
authors.forename: Lawrence
authors.initials: L
authors.lastname: Rudski
authors.affiliation: Department of Cardiology, Ben Gurion University, Beer Sheva, Israel.
authors.forename: Avi
authors.initials: A
authors.lastname: Shimony
authors.affiliation: Department of Diagnostic Imaging, University of Ottawa, Ontario, Canada.
authors.forename: Carole
authors.initials: C
authors.lastname: Dennie
authors.affiliation: Department of Nuclear Medicine, Jewish General Hospital, Montreal, Quebec, Canada.
authors.forename: Chris
authors.initials: C
authors.lastname: Rush
authors.affiliation: Department of Medicine, Dalhousie University, Halifax, NS, Canada.
authors.forename: Paul
authors.initials: P
authors.lastname: Hernandez
authors.affiliation: Department of Medicine, University of Ottawa, and the Ottawa Hospital Research Institute, Ontario, Canada.
authors.forename: Shawn D
authors.initials: SD
authors.lastname: Aaron
authors.affiliation: Department of Medicine, Jewish General Hospital, Montreal, Quebec, Canada.
authors.forename: Andrew M
authors.initials: AM
authors.lastname: Hirsch
mesh_terms: D000328:Adult; D000368:Aged; D000792:Angiography; D000925:Anticoagulants / Q000627:therapeutic use*; D015992:Body Mass Index; D004417:Dyspnea / Q000209:etiology*; D005080:Exercise Test; D017079:Exercise Tolerance; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015337:Multicenter Studies as Topic; D011379:Prognosis; D011446:Prospective Studies; D011655:Pulmonary Embolism / Q000150:complications* / Q000000981:diagnostic imaging / Q000188:drug therapy; D011788:Quality of Life; D017678:Sex Distribution; D018434:Sickness Impact Profile; D016138:Walking
chemical_list: D000925:Anticoagulants
keywords: Functional outcomes; Prognosis; Pulmonary embolism; Quality of life