Efficacy and safety of a 12-week outpatient pulmonary rehabilitation program in Post-PE Syndrome

G.J.A.M. Boon; S.M.J. Janssen; S. Barco; H.J. Bogaard; W. Ghanima; L.J.M. Kroft; L.J. Meijboom; M.K. Ninaber; E.J. Nossent; M.A. Spruit; P. Symersky; H.W. Vliegen; A.V. Noordegraaf; M.V. Huisman; B. Siegerink; J.J. Abbink; F.A. Klok

doi:10.1016/j.thromres.2021.08.012

Efficacy and safety of a 12-week outpatient pulmonary rehabilitation program in Post-PE Syndrome

G.J.A.M. Boon, S.M.J. Janssen, S. Barco, H.J. Bogaard, W. Ghanima, L.J.M. Kroft, L.J. Meijboom, M.K. Ninaber, E.J. Nossent, M.A. Spruit, P. Symersky, H.W. Vliegen, A.V. Noordegraaf, M.V. Huisman, B. Siegerink, J.J. Abbink, F.A. Klok^*

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

Background: The Post-Pulmonary Embolism Syndrome (PPES) comprises heterogeneous entities, including chronic thromboembolic disease with/without pulmonary hypertension (CTEPH/CTEPD), and deconditioning. Objectives: To assess underlying physiological determinants of PPES, and efficacy and safety of rehabilitation training in these patients.Methods: 56 consecutive PE patients with persistent dyspnea and/or functional limitations despite >3 months of anticoagulation underwent standardized diagnostic work-up including exercise testing as part of routine practice. All diagnostic (imaging and cardiopulmonary function) tests were interpreted by a core group of experienced clinicians. A subgroup of patients without CTEPH or other treatable conditions was referred for a 12-week personalized rehabilitation program, studying changes in physical condition and patient-reported outcome measures.Results: Persistent vascular occlusions were observed in 21/56 patients (38%) and CTEPH was confirmed in ten (18%). Regarding those without CTEPH, impaired cardiopulmonary responses were evident in 18/39 patients with available CPET data (46%), unrelated to chronic thrombi. Rehabilitation was completed by 27 patients after excluding 29 (patients with CTEPH or treatable comorbidities, refusal, ineligibility, or training elsewhere). Training intensity, PE-specific quality of life (PEmb-QoL) and fatigue (CIS) improved with a median difference of 20 W (p = 0.001), 3.9 points (p < 0.001) and 16 points (p = 0.003), respectively. Functional status (Post-VTE Functional Status Scale) improved >1 grade in 18 (67%) patients, and declined in one (3.7%).Conclusions: Our findings suggest that abnormal cardiopulmonary responses to exercise are common in patients with PPES and are not limited to those with chronic thrombi. Offering pulmonary rehabilitation to patients not treated otherwise seems safe and promising.

Original language	English
Pages (from-to)	66-75
Number of pages	10
Journal	Thrombosis Research
Volume	206
DOIs	https://doi.org/10.1016/j.thromres.2021.08.012
Publication status	Published - 1 Oct 2021

Keywords

Pulmonary embolism
Pulmonary hypertension
Dyspnea
Rehabilitation
Quality of life
QUALITY-OF-LIFE
VENOUS THROMBOEMBOLISM
DIAGNOSTIC MANAGEMENT
EMBOLISM
ENDARTERECTOMY
HYPERTENSION
LIMITATIONS
GUIDELINES
FATIGUE
VOLUME

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Boon, G. J. A. M., Janssen, S. M. J., Barco, S., Bogaard, H. J., Ghanima, W., Kroft, L. J. M., Meijboom, L. J., Ninaber, M. K., Nossent, E. J., Spruit, M. A., Symersky, P., Vliegen, H. W., Noordegraaf, A. V., Huisman, M. V., Siegerink, B., Abbink, J. J., & Klok, F. A. (2021). Efficacy and safety of a 12-week outpatient pulmonary rehabilitation program in Post-PE Syndrome. Thrombosis Research, 206, 66-75. https://doi.org/10.1016/j.thromres.2021.08.012

@article{a46adc534bd54a1ab7cff31e6a23d8fd,

title = "Efficacy and safety of a 12-week outpatient pulmonary rehabilitation program in Post-PE Syndrome",

abstract = "Background: The Post-Pulmonary Embolism Syndrome (PPES) comprises heterogeneous entities, including chronic thromboembolic disease with/without pulmonary hypertension (CTEPH/CTEPD), and deconditioning. Objectives: To assess underlying physiological determinants of PPES, and efficacy and safety of rehabilitation training in these patients.Methods: 56 consecutive PE patients with persistent dyspnea and/or functional limitations despite >3 months of anticoagulation underwent standardized diagnostic work-up including exercise testing as part of routine practice. All diagnostic (imaging and cardiopulmonary function) tests were interpreted by a core group of experienced clinicians. A subgroup of patients without CTEPH or other treatable conditions was referred for a 12-week personalized rehabilitation program, studying changes in physical condition and patient-reported outcome measures.Results: Persistent vascular occlusions were observed in 21/56 patients (38%) and CTEPH was confirmed in ten (18%). Regarding those without CTEPH, impaired cardiopulmonary responses were evident in 18/39 patients with available CPET data (46%), unrelated to chronic thrombi. Rehabilitation was completed by 27 patients after excluding 29 (patients with CTEPH or treatable comorbidities, refusal, ineligibility, or training elsewhere). Training intensity, PE-specific quality of life (PEmb-QoL) and fatigue (CIS) improved with a median difference of 20 W (p = 0.001), 3.9 points (p < 0.001) and 16 points (p = 0.003), respectively. Functional status (Post-VTE Functional Status Scale) improved >1 grade in 18 (67%) patients, and declined in one (3.7%).Conclusions: Our findings suggest that abnormal cardiopulmonary responses to exercise are common in patients with PPES and are not limited to those with chronic thrombi. Offering pulmonary rehabilitation to patients not treated otherwise seems safe and promising.",

keywords = "Pulmonary embolism, Pulmonary hypertension, Dyspnea, Rehabilitation, Quality of life, QUALITY-OF-LIFE, VENOUS THROMBOEMBOLISM, DIAGNOSTIC MANAGEMENT, EMBOLISM, ENDARTERECTOMY, HYPERTENSION, LIMITATIONS, GUIDELINES, FATIGUE, VOLUME",

author = "G.J.A.M. Boon and S.M.J. Janssen and S. Barco and H.J. Bogaard and W. Ghanima and L.J.M. Kroft and L.J. Meijboom and M.K. Ninaber and E.J. Nossent and M.A. Spruit and P. Symersky and H.W. Vliegen and A.V. Noordegraaf and M.V. Huisman and B. Siegerink and J.J. Abbink and F.A. Klok",

note = "Funding Information: MAS reports grants from Lung Foundation Netherlands, grants from Stichting Astma Bestrijding, grants from and speaker fees from AstraZeneca and grants and speakers fees from Boehringer Ingelheim, outside the submitted work. Funding Information: MVH reports grants from ZonMW Dutch Healthcare Fund, grants and personal fees from Pfizer-BMS, grants and personal fees from Bayer Health Care, grants and personal fees from Daiichi-Sankyo, grants from Leo Pharma, outside the submitted work. Funding Information: GJAMB was supported by the Dutch Heart Foundation (2017T064). Funding Information: FAK reports research grants from Bayer, Bristol-Myers Squibb, Boehringer-Ingelheim, Daiichi-Sankyo, MSD and Actelion, the Dutch Heart foundation (2017T064) and the Dutch Thrombosis association, all outside the submitted work. Funding Information: AVN reports grants from Netherlands CardioVascular Research Initiative, grants from Netherlands Organization for Scientific Research, other from Johnson & Johnson and Ferrer in the past 3 years, non-financial support from member of scientific advisory board of Morphogen-XI, outside the submitted work. Funding Information: This work was supported by unrestricted grants from Bayer / Merck Sharp & Dohme (MSD) and Actelion Pharmaceuticals Ltd . Publisher Copyright: {\textcopyright} 2021 The Authors",

year = "2021",

month = oct,

day = "1",

doi = "10.1016/j.thromres.2021.08.012",

language = "English",

volume = "206",

pages = "66--75",

journal = "Thrombosis Research",

issn = "0049-3848",

publisher = "Elsevier Science",

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Boon, GJAM, Janssen, SMJ, Barco, S, Bogaard, HJ, Ghanima, W, Kroft, LJM, Meijboom, LJ, Ninaber, MK, Nossent, EJ, Spruit, MA, Symersky, P, Vliegen, HW, Noordegraaf, AV, Huisman, MV, Siegerink, B, Abbink, JJ & Klok, FA 2021, 'Efficacy and safety of a 12-week outpatient pulmonary rehabilitation program in Post-PE Syndrome', Thrombosis Research, vol. 206, pp. 66-75. https://doi.org/10.1016/j.thromres.2021.08.012

TY - JOUR

T1 - Efficacy and safety of a 12-week outpatient pulmonary rehabilitation program in Post-PE Syndrome

AU - Boon, G.J.A.M.

AU - Janssen, S.M.J.

AU - Barco, S.

AU - Bogaard, H.J.

AU - Ghanima, W.

AU - Kroft, L.J.M.

AU - Meijboom, L.J.

AU - Ninaber, M.K.

AU - Nossent, E.J.

AU - Spruit, M.A.

AU - Symersky, P.

AU - Vliegen, H.W.

AU - Noordegraaf, A.V.

AU - Huisman, M.V.

AU - Siegerink, B.

AU - Abbink, J.J.

AU - Klok, F.A.

N1 - Funding Information: MAS reports grants from Lung Foundation Netherlands, grants from Stichting Astma Bestrijding, grants from and speaker fees from AstraZeneca and grants and speakers fees from Boehringer Ingelheim, outside the submitted work. Funding Information: MVH reports grants from ZonMW Dutch Healthcare Fund, grants and personal fees from Pfizer-BMS, grants and personal fees from Bayer Health Care, grants and personal fees from Daiichi-Sankyo, grants from Leo Pharma, outside the submitted work. Funding Information: GJAMB was supported by the Dutch Heart Foundation (2017T064). Funding Information: FAK reports research grants from Bayer, Bristol-Myers Squibb, Boehringer-Ingelheim, Daiichi-Sankyo, MSD and Actelion, the Dutch Heart foundation (2017T064) and the Dutch Thrombosis association, all outside the submitted work. Funding Information: AVN reports grants from Netherlands CardioVascular Research Initiative, grants from Netherlands Organization for Scientific Research, other from Johnson & Johnson and Ferrer in the past 3 years, non-financial support from member of scientific advisory board of Morphogen-XI, outside the submitted work. Funding Information: This work was supported by unrestricted grants from Bayer / Merck Sharp & Dohme (MSD) and Actelion Pharmaceuticals Ltd . Publisher Copyright: © 2021 The Authors

PY - 2021/10/1

Y1 - 2021/10/1

N2 - Background: The Post-Pulmonary Embolism Syndrome (PPES) comprises heterogeneous entities, including chronic thromboembolic disease with/without pulmonary hypertension (CTEPH/CTEPD), and deconditioning. Objectives: To assess underlying physiological determinants of PPES, and efficacy and safety of rehabilitation training in these patients.Methods: 56 consecutive PE patients with persistent dyspnea and/or functional limitations despite >3 months of anticoagulation underwent standardized diagnostic work-up including exercise testing as part of routine practice. All diagnostic (imaging and cardiopulmonary function) tests were interpreted by a core group of experienced clinicians. A subgroup of patients without CTEPH or other treatable conditions was referred for a 12-week personalized rehabilitation program, studying changes in physical condition and patient-reported outcome measures.Results: Persistent vascular occlusions were observed in 21/56 patients (38%) and CTEPH was confirmed in ten (18%). Regarding those without CTEPH, impaired cardiopulmonary responses were evident in 18/39 patients with available CPET data (46%), unrelated to chronic thrombi. Rehabilitation was completed by 27 patients after excluding 29 (patients with CTEPH or treatable comorbidities, refusal, ineligibility, or training elsewhere). Training intensity, PE-specific quality of life (PEmb-QoL) and fatigue (CIS) improved with a median difference of 20 W (p = 0.001), 3.9 points (p < 0.001) and 16 points (p = 0.003), respectively. Functional status (Post-VTE Functional Status Scale) improved >1 grade in 18 (67%) patients, and declined in one (3.7%).Conclusions: Our findings suggest that abnormal cardiopulmonary responses to exercise are common in patients with PPES and are not limited to those with chronic thrombi. Offering pulmonary rehabilitation to patients not treated otherwise seems safe and promising.

AB - Background: The Post-Pulmonary Embolism Syndrome (PPES) comprises heterogeneous entities, including chronic thromboembolic disease with/without pulmonary hypertension (CTEPH/CTEPD), and deconditioning. Objectives: To assess underlying physiological determinants of PPES, and efficacy and safety of rehabilitation training in these patients.Methods: 56 consecutive PE patients with persistent dyspnea and/or functional limitations despite >3 months of anticoagulation underwent standardized diagnostic work-up including exercise testing as part of routine practice. All diagnostic (imaging and cardiopulmonary function) tests were interpreted by a core group of experienced clinicians. A subgroup of patients without CTEPH or other treatable conditions was referred for a 12-week personalized rehabilitation program, studying changes in physical condition and patient-reported outcome measures.Results: Persistent vascular occlusions were observed in 21/56 patients (38%) and CTEPH was confirmed in ten (18%). Regarding those without CTEPH, impaired cardiopulmonary responses were evident in 18/39 patients with available CPET data (46%), unrelated to chronic thrombi. Rehabilitation was completed by 27 patients after excluding 29 (patients with CTEPH or treatable comorbidities, refusal, ineligibility, or training elsewhere). Training intensity, PE-specific quality of life (PEmb-QoL) and fatigue (CIS) improved with a median difference of 20 W (p = 0.001), 3.9 points (p < 0.001) and 16 points (p = 0.003), respectively. Functional status (Post-VTE Functional Status Scale) improved >1 grade in 18 (67%) patients, and declined in one (3.7%).Conclusions: Our findings suggest that abnormal cardiopulmonary responses to exercise are common in patients with PPES and are not limited to those with chronic thrombi. Offering pulmonary rehabilitation to patients not treated otherwise seems safe and promising.

KW - Pulmonary embolism

KW - Pulmonary hypertension

KW - Dyspnea

KW - Rehabilitation

KW - Quality of life

KW - QUALITY-OF-LIFE

KW - VENOUS THROMBOEMBOLISM

KW - DIAGNOSTIC MANAGEMENT

KW - EMBOLISM

KW - ENDARTERECTOMY

KW - HYPERTENSION

KW - LIMITATIONS

KW - GUIDELINES

KW - FATIGUE

KW - VOLUME

U2 - 10.1016/j.thromres.2021.08.012

DO - 10.1016/j.thromres.2021.08.012

M3 - Article

C2 - 34419865

SN - 0049-3848

VL - 206

SP - 66

EP - 75

JO - Thrombosis Research

JF - Thrombosis Research

ER -