Quality of life 1 month after acute pulmonary embolism in emergency department patients.

Autor: Weekes AJ; Department of Emergency Medicine, Atrium Health's Carolinas Medical Center, Charlotte, North Carolina, USA., Davison J; Department of Emergency Medicine, Orlando Health, Orlando, Florida, USA., Lupez K; Department of Emergency Medicine, Atrium Health's Carolinas Medical Center, Charlotte, North Carolina, USA.; Department of Emergency Medicine, Tufts Medical Center, Boston, Massachusetts, USA., Raper JD; Department of Emergency Medicine, Atrium Health's Carolinas Medical Center, Charlotte, North Carolina, USA.; Department of Emergency Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA., Thomas AM; Department of Emergency Medicine, Atrium Health's Carolinas Medical Center, Charlotte, North Carolina, USA.; Emergency Department, Houston Methodist Baytown Hospital, Houston, Texas, USA., Cox CA; Department of Emergency Medicine, Atrium Health's Carolinas Medical Center, Charlotte, North Carolina, USA.; Emergency Medicine of Idaho, Meridian, Idaho, USA., Esener D; Department of Emergency Medicine, Kaiser Permanente, San Diego, California, USA., Boyd JS; Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA., Nomura JT; Department of Emergency Medicine, Christiana Care, Newark, Delaware, USA., Murphy K; Department of Emergency Medicine, Christiana Care, Newark, Delaware, USA., Ockerse PM; Department of Emergency Medicine, University of Utah Health, Salt Lake City, Utah, USA., Leech S; Department of Emergency Medicine, Orlando Health, Orlando, Florida, USA., Johnson J; Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA., Abrams E; Department of Emergency Medicine, Kaiser Permanente, San Diego, California, USA., Kelly C; Department of Emergency Medicine, University of Utah Health, Salt Lake City, Utah, USA., O'Connell NS; Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA.
Jazyk: angličtina
Zdroj: Academic emergency medicine : official journal of the Society for Academic Emergency Medicine [Acad Emerg Med] 2023 Aug; Vol. 30 (8), pp. 819-831. Date of Electronic Publication: 2023 Mar 08.
DOI: 10.1111/acem.14692
Abstrakt: Objective: The Pulmonary Embolism Quality-of-Life (PEmb-QoL) questionnaire assesses quality of life (QoL) after pulmonary embolism (PE). We aimed to determine whether any clinical or pathophysiologic features of PE were associated with worse PEmb-QoL scores 1 month after PE.
Methods: In this prospective multicenter registry, we conducted PEmb-QoL questionnaires. We determined differences in QoL domain scores for four primary variables: clinical deterioration (death, cardiac arrest, respiratory failure, hypotension requiring fluid bolus, catecholamine support, or new dysrhythmia), right ventricular dysfunction (RVD), PE risk stratification, and subsequent rehospitalization. For overall QoL score, we fit a multivariable regression model that included these four primary variables as independent variables.
Results: Of 788 PE patients participating in QoL assessments, 156 (19.8%) had a clinical deterioration event, 236 (30.7%) had RVD of which 38 (16.1%) had escalated interventions. For those without and with clinical deterioration, social limitations had mean (±SD) scores of 2.07 (±1.27) and 2.36 (±1.47), respectively (p = 0.027). For intensity of complaints, mean (±SD) scores for patients without RVD (4.32 ± 2.69) were significantly higher than for those with RVD with or without reperfusion interventions (3.82 ± 1.81 and 3.83 ± 2.11, respectively; p = 0.043). There were no domain score differences between PE risk stratification groups. All domain scores were worse for patients with rehospitalization versus without. By multivariable analysis, worse total PEmb-QoL scores with effect sizes were subsequent rehospitalization 11.29 (6.68-15.89), chronic obstructive pulmonary disease (COPD) 8.17 (3.91-12.43), and longer index hospital length of stay 0.06 (0.03-0.08).
Conclusions: Acute clinical deterioration, RVD, and PE severity were not predictors of QoL at 1 month post-PE. Independent predictors of worsened QoL were rehospitalization, COPD, and index hospital length of stay.
(© 2023 The Authors. Academic Emergency Medicine published by Wiley Periodicals LLC on behalf of Society for Academic Emergency Medicine.)
Databáze: MEDLINE
Externí odkaz: