Health-related quality of life and mortality in patients with pulmonary embolism: a prospective cohort study in seven European countries

Ling-Hsiang Chuang,Patrick Mismetti,Manuel Monreal,Ben Van Hout,Alexander Cohen,Anselm Gitt,Giancarlo Agnelli,Stephen N Willich,David Jimenez,Pearl Gumbs,Sonja Kroep,Rupert Bauersachs

doi:10.1007/s11136-019-02175-z

Abstract

PurposeLittle is known about the quality of life following pulmonary embolism (PE). The aim of the study was to assess the 12-month illness burden in terms of health-related quality of life (HrQoL) and mortality, in relation to differences in patient characteristics.MethodsThe PREFER in VTE registry, a prospective, observational study conducted in seven European countries, was used. Within 2 weeks following an acute symptomatic PE, patients were recruited and followed up for 12 months. Associations between patient characteristics and HrQoL (EQ-5D-5L) and mortality were examined using a regression approach.ResultsAmong 1399 PE patients, the EQ-5D-5L index score at baseline was 0.712 (SD 0.265), which among survivors gradually improved to 0.835 (0.212) at 12 months. For those patients with and without active cancer, the average index score at baseline was 0.658 (0.275) and 0.717 (0.264), respectively. Age and previous stroke were significant factors for predicting index scores in those with/without active cancer. Bleeding events but not recurrences had a noticeable impact on the HrQoL of patients without active cancer. The 12-month mortality rate post-acute period was 8.1%, ranging from 1.4% in Germany, Switzerland, and Austria to 16.8% in Italy. Mortality differed between patients with active cancer and those without (42.7% vs. 4.7%).ConclusionPE is associated with a substantial decrease in HrQoL at baseline which normalizes following treatment. PE is associated with a high mortality rate especially in patients with cancer, with significant country variation. Bleeding events, in particular, impact the burden of PE.

Highlights

Pulmonary embolism (PE) is a relatively common emergency [1, 2]
This study aimed to contribute to the current knowledge on the health-related quality of life (HrQoL) of patients with PE in Europe using the results from the PREFER in venous thromboembolism (VTE) registry
The registry enrolled 1399 PE patients, and baseline characteristics are listed in Table 1. 25.2% of patients were from France, followed by Italy 23.7%, Spain 23.4%, DACH 17.2%, and UK 10.5%

Summary

Introduction

Pulmonary embolism (PE) is a relatively common emergency [1, 2]. PE may be unprovoked or as a complication of underlying diseases such as cancer, medical conditions, and surgical procedures. Several empirical estimates of PE incidence rate from European cohort studies have been reported, ranging from 0.19 to 0.6 per 1000 population per year [3,4,5,6,7,8]. An incidence-based epidemiological model estimated that the PE incidence rate is 0.95 per 1000 population per year in the European Union [9]. Long-term morbidity is related to an increased risk of developing recurrent VTE, bleeding, and post-VTE complications including chronic thromboembolic pulmonary hypertension (CTEPH) syndrome and post-thrombotic

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