Abstract Number: PB2457
Meeting: ISTH 2020 Congress
Background: Patients with pulmonary embolism (PE) may suffer from long-term consequences, including decreased functional capacity with chronic exercise limitations. Data on pulmonary rehabilitation (PR) in patients with PE are scarce, and no data about effects of outpatient PR in PE patients are available so far.
Aims: To investigate the effect of outpatient PR in PE patients with persisting symptoms.
Methods: We analyzed data of 22 PE patients, who attended outpatient PR between 2012 and 2019. The reason for admission to PR was PE with exertional dyspnea in all patients. Patients underwent a multi-professional and individualized 6-week PR program. Three times a week for 3-4 hours participants completed exercise training, physiotherapy, and patient education seminars. The primary outcome was change in 6-minute walk test (6MWT) after completion of PR. Secondary outcomes included assessments of cycle ergometer exercises (peak performance, constant work rate test), upper and lower extremity strength and inspiratory muscle strength performed at admission and discharge of PR. To assess long-term benefits, follow-up was performed in median 39 months after PR.
Results: Patients started PR in median 19 weeks after the acute PE event. Their median age was 47.5 (interquartile range 42.5-54.3) years, 7 (32.8%) were women and all presented with NYHA class II and higher. After PR, patients showed significant and clinically relevant improvements in 6MWT (mean difference: 49.4m [95% confidence interval 32.0, 66.8]). Similarly, patients increased performance of cycle ergometer exercises and inspiratory muscle strength (data shown in table 2). At long-term follow-up, 78% of patients reported improved health status when asked to compare it to their status before admission to PR.
Conclusions: We observed significant improvements in exercise capacity in PE patients undergoing outpatient PR. The majority of patients reported also a long-term improvement in health status. Prospective studies are needed to identify patients who would benefit most from a structured PR.
|Variable||No. with data (n=22)||Count (%)|
|DVT present at index event||21||12 (57.1%)|
|Unprovoked PE||22||13 (59.1%)|
|Provoked PE||22||9 (40.9%)|
|History of venous thromboembolism||22||7 (31.2%)|
|Arterial hypertension||22||10 (45.5%)|
|Chronic obstructive pulmonary disease||22||2 (9%)|
|History of acute lymphatic leukemia||22||1 (4.5%)|
[Table 1. PE characteristics and Comorbidities]
|Assessment (Measurement)||No. with data (n=22)||Admission||Discharge||Difference (Percent)||p-value|
|6-minute walk test||20||556.1 (±104.8)||605.5 (±96.0)||+ 49.4 (9%)||< .001|
|1-minute sit-to-stand test||14||35.1 (±12.6)||39.0(±14.3)||+ 3.9 (11%)||.034|
|Maximal inspiratory pressure||22||94.7 (±30.4)||125.2 (±27.0)||+ 30.5 (32%)||< .001|
|Maximal Workload (Watt)||18||156.8 (±63.6)||188.5 (±57.1)||+ 31.7 (20%)||< .001|
|Constant work rate test (min)||14||12.7 (±6.7)||21.2 (±7.7)||+ 8.5 (67%)||.002|
|Lower extremity strength (kg)||11||117 (±17.9)||146.9 (±16.5)||+ 29.9 (26%)||< .001|
|Upper extremity strength (kg)||16||34.9 (±12.6)||44.5 (±11.7)||+ 9.6 (28%)||< .001|
[Table 2. Exercise parameters at admission to outpatient pulmonary rehabilitation and reassessment at completion of pulmonary rehabilitation]
To cite this abstract in AMA style:Nopp S, Klok FA, Moik F, Petrovic M, Derka I, Ay C, Zwick RH. Improvements in Short- and Long-term Outcomes in Patients with Pulmonary Embolism after Outpatient Pulmonary Rehabilitation [abstract]. Res Pract Thromb Haemost. 2020; 4 (Suppl 1). https://abstracts.isth.org/abstract/improvements-in-short-and-long-term-outcomes-in-patients-with-pulmonary-embolism-after-outpatient-pulmonary-rehabilitation/. Accessed April 11, 2021.
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