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Outpatient Pulmonary Rehabilitation in Patients with Persisting Symptoms after Pulmonary Embolism.

ABSTRACT: Background: Patients with pulmonary embolism (PE) may suffer from long-term consequences, including decreased functional capacity. Data on pulmonary rehabilitation (PR) in patients with PE are scarce, and no data on outpatient PR are available so far. Methods: We analyzed data of 22 PE patients who attended outpatient PR due to exertional dyspnea. Patients underwent a multi-professional 6-week PR program. The primary outcome was change in 6-min walk test (6MWT). Secondary outcomes included changes in strength and endurance tests. To assess long-term benefits, follow-up was performed a median of 39 months after PR. Results: Patients started PR a median of 19 weeks after the acute PE event. Their median age was 47.5 years, 33% were women and all presented with NYHA (New York Heart Association) class II and higher. After PR, patients showed significant and clinically relevant improvements in 6MWT (mean difference: 49.4 m [95% CI 32.0-66.8]). Similarly, patients increased performance in maximum strength, endurance and inspiratory muscle strength. At long-term follow-up, 78% of patients reported improved health. Conclusion: We observed significant improvements in exercise capacity in PE patients undergoing outpatient PR. The majority of patients also reported a long-term improvement in health status. Prospective studies are needed to identify patients who would benefit most from structured PR.

SUBMITTER: Nopp S

PROVIDER: S-EPMC7355580 | biostudies-literature | 2020 Jun

REPOSITORIES: biostudies-literature

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Outpatient Pulmonary Rehabilitation in Patients with Persisting Symptoms after Pulmonary Embolism.

Nopp Stephan S Klok Frederikus A FA Moik Florian F Petrovic Milos M Derka Irmgard I Ay Cihan C Zwick Ralf Harun RH

Journal of clinical medicine 20200610 6

<b>Background:</b> Patients with pulmonary embolism (PE) may suffer from long-term consequences, including decreased functional capacity. Data on pulmonary rehabilitation (PR) in patients with PE are scarce, and no data on outpatient PR are available so far. <b>Methods:</b> We analyzed data of 22 PE patients who attended outpatient PR due to exertional dyspnea. Patients underwent a multi-professional 6-week PR program. The primary outcome was change in 6-min walk test (6MWT). Secondary outcomes ...[more]

PMID: 32532020

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Project description:BackgroundMost patients with pulmonary embolism (PE) spend 5-7 days in hospital even though only 4.5% will develop serious complications during this time. In particular, the group of patients with incidentally diagnosed PE (i-PE) includes many patients with low risk features potentially ideal for outpatient management; however the evidence for their optimal management is lacking hence relative practices may vary considerably. We describe the development process, components, links and function of a nurse-led service for the management of patients with i-PE, developed in accordance to the UK Medical Research Council complex intervention guidance.MethodsPhase 0 (Theoretical underpinning): The Pulmonary Embolism Severity Index (PESI) was selected for patient risk assessment and the American Society of Clinical Oncology (ASCO) guideline for the management of PE in cancer patients (2007) was selected as quality measure. Historical registry and audit data from our centre regarding i-PE incidence and management for the period between 2006 and 2009 illustrating the then current practices were reviewed. Phase 1 (Modelling): Modelling of the pathway included the following: a) Identification of training needs, planning and implementation of training schemes and development of transferable competencies and training materials. b) Mapping patient pathways and flow and c) Production of key documentation and Standard Operating Procedures for the delivery of the service.ResultsPhase 2 (Implementation and testing of the intervention): During the initial 12 months of implementation, remedial action was taken to address identified deficiencies regarding patient referral to the pathway, compliance with treatment protocol, patient follow up, selection challenges from the use of PESI in cancer patients and challenges regarding the "first-pass" identification of i-PE.ConclusionWe have developed and piloted a complex intervention to manage cancer patients with incidental PE in an outpatient setting. Adherence to evidence- based care, improvement of communication between professionals and patients, and improved quality of data is demonstrated.

Project description:ImportanceThe prevalence of pulmonary embolism in patients with chronic obstructive pulmonary disease (COPD) and acutely worsening respiratory symptoms remains uncertain.ObjectiveTo determine the prevalence of pulmonary embolism in patients with COPD admitted to the hospital for acutely worsening respiratory symptoms.Design, setting, and participantsMulticenter cross-sectional study with prospective follow-up conducted in 7 French hospitals. A predefined pulmonary embolism diagnostic algorithm based on Geneva score, D-dimer levels, and spiral computed tomographic pulmonary angiography plus leg compression ultrasound was applied within 48 hours of admission; all patients had 3-month follow-up. Patients were recruited from January 2014 to May 2017 and the final date of follow-up was August 22, 2017.ExposuresAcutely worsening respiratory symptoms in patients with COPD.Main outcomes and measuresThe primary outcome was pulmonary embolism diagnosed within 48 hours of admission. Key secondary outcome was pulmonary embolism during a 3-month follow-up among patients deemed not to have venous thromboembolism at admission and who did not receive anticoagulant treatment. Other outcomes were venous thromboembolism (pulmonary embolism and/or deep vein thrombosis) at admission and during follow-up, and 3-month mortality, whether venous thromboembolism was clinically suspected or not.ResultsAmong 740 included patients (mean age, 68.2 years [SD, 10.9 years]; 274 women [37.0%]), pulmonary embolism was confirmed within 48 hours of admission in 44 patients (5.9%; 95% CI, 4.5%-7.9%). Among the 670 patients deemed not to have venous thromboembolism at admission and who did not receive anticoagulation, pulmonary embolism occurred in 5 patients (0.7%; 95% CI, 0.3%-1.7%) during follow-up, including 3 deaths related to pulmonary embolism. The overall 3-month mortality rate was 6.8% (50 of 740; 95% CI, 5.2%-8.8%). The proportion of patients who died during follow-up was higher among those with venous thromboembolism at admission than the proportion of those without it at admission (14 [25.9%] of 54 patients vs 36 [5.2%] of 686; risk difference, 20.7%, 95% CI, 10.7%-33.8%; P < .001). The prevalence of venous thromboembolism was 11.7% (95% CI, 8.6%-15.9%) among patients in whom pulmonary embolism was suspected (n = 299) and was 4.3% (95% CI, 2.8%-6.6%) among those in whom pulmonary embolism was not suspected (n = 441).Conclusions and relevanceAmong patients with chronic obstructive pulmonary disease admitted to the hospital with an acute worsening of respiratory symptoms, pulmonary embolism was detected in 5.9% of patients using a predefined diagnostic algorithm. Further research is needed to understand the possible role of systematic screening for pulmonary embolism in this patient population.

Project description:ObjectiveTo assess whether patients undergoing outpatient cardiac rehabilitation who have frailty and depressive symptoms at discharge are less likely than those without these condition to establish positive exercise habits.DesignA retrospective cohort study that involved the assessment of frailty and depressive symptoms at the end of a 3-month course of cardiac rehabilitation. Frailty was defined as the patient noting 3 or more items using the criteria of Fried et al, while depressive symptoms were delineated by Patient Health Questionnaire-9 (PHQ-9) scores of 10 or greater.SettingGeneral hospital (1048 beds) with outpatient cardiac rehabilitation in a suburb location in Japan.Participants344 individuals underwent outpatient cardiac rehabilitation during the January 1, 2019-June 1, 2022, study period. Of these, 48 individuals were excluded because they did not complete the course and 54 were excluded because they lacked outcome data. Finaly, 242 individuals (mean age: 68.2±11.1 years) were analyzed.InterventionsNot applicable.Main outcome variableThe establishment of an exercise habit defined as exercising at least 2 days per week and 30 minutes per day.ResultsParticipants were divided into 4 groups depending upon the presence or absence of frailty and depressive symptoms: non-frail with no reported depressive symptoms (173 subjects), frailty-only (21 subjects), depressive symptoms-only (38 subjects), and frailty and depressive symptoms (10 subjects). Compared with patients who were not depressed and not frail, those with frailty only (odds ratio [OR]: 0.43, 95% confidence interval: 0.21-0.88, P=.02) and those with frailty and depressive symptoms (OR: 0.21, 95% confidence interval: 0.05-0.82, P=.025) had significantly lower ORs for establishing exercise habits. After multivariate adjustment, the OR of establishing an exercise habit was significantly lower in those with only frailty (OR: 0.35, 95% confidence interval: 0.14-0.85, P=.005).ConclusionsThis study, while limited by the small number of subjects with both frailty and depressive symptoms, indicates that interventions to prevent frailty during hospitalization and cardiac rehabilitation may be essential for cardiovascular disease patients with frailty whether or not associated with depressive symptoms.

Dataset Information

Outpatient Pulmonary Rehabilitation in Patients with Persisting Symptoms after Pulmonary Embolism.

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Outpatient Pulmonary Rehabilitation in Patients with Persisting Symptoms after Pulmonary Embolism.

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