Effectiveness and Safety of Pulmonary Rehabilitation to Reduce Functional Impairment Based on the Post-PE Syndrome

G.J.A.M. Boon¹, S.M.J. Janssen², S. Barco^3,4, H.J. Bogaard⁵, W. Ghanima⁶, L.J.M. Kroft⁷, L.J. Meijboom⁸, M.K. Ninaber⁹, E.J. Nossent¹⁰, P. Symersky¹¹, H.W. Vliegen¹², A. Vonk Noordegraaf¹⁰, M.V. Huisman¹, B. Siegerink^13,14, J.J. Abbink², F.A. Klok¹

¹Leiden University Medical Center, Department of Medicine - Thrombosis and Hemostasis, Leiden, the Netherlands, ²Basalt Rehabilitation Center, Leiden, the Netherlands, ³University Medical Center Mainz, Center for Thrombosis and Hemostasis (CTH), Mainz, Germany, ⁴University Hospital of Zurich, Clinic of Angiology, Zurich, Switzerland, ⁵Amsterdam UMC, VU University Medical Center, Department of Pulmonology, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands, ⁶Østfold Hospital Trust, Departments of Oncology, Medicine and Research, Kalnes, Norway, ⁷Leiden University Medical Center, Leiden, Department of Radiology, Leiden, the Netherlands, ⁸Amsterdam UMC, VU University Medical Center, Department of Radiology and Nuclear medicine, Amsterdam, the Netherlands, ⁹Leiden University Medical Center, Department of Pulmonology, Leiden, the Netherlands, ¹⁰Department of Pulmonology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, VU University Medical Center, Amsterdam, the Netherlands, ¹¹Department of Cardiac Surgery, Amsterdam UMC, VU University Medical Center, Amsterdam, the Netherlands, ¹²Leiden University Medical Center, Department of Cardiology, Leiden, the Netherlands, ¹³Charité Universitätsmedizin Berlin, Center for Stroke Research Berlin, Berlin, Germany, ¹⁴Leiden University Medical Center, Department of Clinical Epidemiology, Leiden, the Netherlands

Abstract Number: PB2211

Meeting: ISTH 2020 Congress

Theme: Venous Thromboembolism and Cardioembolism » Post-thrombotic Syndrome

Background: Half of patients report persistent dyspnea and functional impairment months to years after an episode of acute PE. Within this post-PE syndrome, the most severe cause is chronic thromboembolic pulmonary hypertension (CTEPH), which can be treated by surgery, angioplasty or pharmacotherapy. Most patients however have chronic thromboembolic pulmonary disease or are deconditioned, for which no optimal treatment strategy is currently available.

Aims: To assess the effectiveness and safety of a PE-specific rehabilitation program aimed at reducing post-PE syndrome based functional impairment.

Methods: Consecutive patients with the post-PE syndrome were referred to a specialist rehabilitation center for a 12-week personalized rehabilitation program, after CTEPH was ruled out. Disease-specific quality of life (PEmb-QoL) and maximal workload on ergometry were measured prospectively and the recently developed Post-VTE Functional Status (PVFS) Scale (Klok et al. Thromb Res 2019) was assessed post-hoc prior to start and at the end of the rehabilitation program.

Results: 22 patients started rehabilitation: 13 were female (59%) and mean age was 52 years (SD13). Median time since last PE diagnosis was 6.3 months. Median achieved maximal workload during first training was 56% of predicted (15-82%), and improved to 65% (40-165%) during final training (p< 0.003). PEmb-Qol improved after rehabilitation: mean difference was 4.1 points (95%CI 2.3 to 6.0; Figure 1). Rehabilitation resulted in significant improvement on the PVFS scale (p< 0.001) with a number needed to treat of 4 for one patient to improve in functional status (Figure 2). One patient was diagnosed with atrial fibrillation; no other complications occurred.

Conclusions: Patients with post-PE syndrome who completed the PE-specific pulmonary rehabilitation program improved in terms of maximum workload, quality of life and functional status. Our data support offering pulmonary rehabilitation to this patient group, but randomized studies are needed to validate our findings.

[Figure 1: Radar chart representing the change in all dimensions of the PEmb-Qol questionnaire before and after the rehabilitation program; lower score]

[Figure 2: Assignments of PVFS scale grades before and after completing the 12-week pulmonary rehabilitation program ]

To cite this abstract in AMA style:

Boon GJAM, Janssen SMJ, Barco S, Bogaard HJ, Ghanima W, Kroft LJM, Meijboom LJ, Ninaber MK, Nossent EJ, Symersky P, Vliegen HW, Vonk Noordegraaf A, Huisman MV, Siegerink B, Abbink JJ, Klok FA. Effectiveness and Safety of Pulmonary Rehabilitation to Reduce Functional Impairment Based on the Post-PE Syndrome [abstract]. Res Pract Thromb Haemost. 2020; 4 (Suppl 1). https://abstracts.isth.org/abstract/effectiveness-and-safety-of-pulmonary-rehabilitation-to-reduce-functional-impairment-based-on-the-post-pe-syndrome/. Accessed October 1, 2023.

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