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.

Keywords: dyspnea; exercise training; outpatient; pulmonary embolism; pulmonary rehabilitation.

Figure 1

(a) Improvements in 6MWT (6-min walk test) at completion of pulmonary rehabilitation. 6MWT improved significantly after completion of pulmonary rehabilitation. (b) Individual patients’ results for 6MWT at admission and discharge are presented on the right. Thirteen patients improved above a minimal clinical important difference of 30.5 m (blue line). Six patients improved but were below the minimal clinical important difference (green line). One patient did not improve (red line); Abb.: 6MWT, 6-min walk test; ** = p < 0.001, paired samples t-test.

Figure 2

Improvements in secondary outcome parameters after completion of pulmonary rehabilitation. Patients improved significantly in 1-MSTS, maximal inspiratory muscle strength, maximal workload, constant work rate, lower and upper extremity strength; * = p < 0.05; ** = p < 0.001, paired samples t-test.

Figure 3

(a) Post-VTE (venous thromboembolism) functional status scale and patient-reported health status at long-term follow up. 0, No significant functional limitations; 2, Slight functional limitations; 3, Moderate functional limitations; 4, Severe functional limitations. (b) 78% reported much better or better health status compared to before admission to pulmonary rehabilitation.

Figure 3

(a) Post-VTE (venous thromboembolism) functional status scale and patient-reported health status at long-term follow up. 0, No significant functional limitations; 2, Slight functional limitations; 3, Moderate functional limitations; 4, Severe functional limitations. (b) 78% reported much better or better health status compared to before admission to pulmonary rehabilitation.