Burden and long-term impact of pulmonary embolism on health-related quality of life : a matched cohort study

Abstract

Aims It has not been conclusively established whether and to what extent pulmonary embolism (PE) affects health-related quality of life (HrQoL). We aimed to assess the long-term independent association of PE with HrQoL to provide reference values for interventional studies and support quantification of the burden of PE in terms of quality- or disability-adjusted life years (QALYs and DALYs).

Methods and results A total of 1005 patients from a prospective multicenter study, followed 3 and 12 months after PE, were successfully matched to 3058 individuals from the general population of the same country based on age, sex, and key comorbidities. Differences between acute PE survivors and matched controls in the ordinal EQ-5D-5L HrQoL dimensions were assessed using multivariable ordinal regression, in the HrQoL index (reflecting overall HrQoL) using multivariable-adjusted mixed linear regression. Both multiple imputation and complete case analysis were performed. Compared with controls, patients reported worse HrQoL in the dimensions self-care, usual activities, and anxiety/depression, and worse HrQoL index at both 3 [adjusted difference −0.04 (95% CI: −0.06, −0.039) in a range from 0 to 1] and 12 months [−0.02 (95% CI: −0.04, −0.01)] in the imputation analysis. Complete case analysis showed similar results. The annual disability weight of PE for DALY calculation was conservatively estimated at 0.03 (95% CI: 0.02, 0.04).

Conclusion PE was independently associated with a moderate decrease in HrQoL, which persisted 12 months after the acute episode despite partial recovery over time. This degree of impairment is comparable to that imposed by several other cardiopulmonary diseases.