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Post-pulmonary embolism impairment frequent, follow-up urged after acute PE

NEW YORK 19/05 - In a large study of patients with acute pulmonary embolism (PE), chronic thromboembolic pulmonary hypertension (CTEPH) was rare, but post-pulmonary embolism impairment (PPEI) was not.

Researchers suggest systematic follow-up after acute PE to reduce PPEI risk and optimize outcomes.

"Since PE is a frequent disease and CTEPH is rare, it is neither feasible nor reasonable to perform a large number of time-consuming and expensive tests in every patient after the acute disease," Dr. Stavros Konstantinides of the University Medical Center of the Johannes Gutenberg University in Mainz, Germany, told Reuters Health by email.

"The FOCUS (FOllow-up after aCUte pulmonary emboliSm) study identified some clinical, ultrasound and laboratory findings, which can easily be obtained three months after acute PE - an early check-up visit already recommended by guidelines - and can then direct the physician to more comprehensive testing only if (the results) are abnormal," he said.

"Even if there are only a few patients are diagnosed with CTEPH after PE, the FOCUS study could identify many others who continue to complain of shortness of breath or exhaustion, and generally a poor quality of life," he added. "These are the patients to whom appropriate care - such as exercise rehabilitation, behavioral education, and lifestyle modification in general - should be provided to restore their health and well-being."

As reported in the European Heart Journal, Dr. Konstantinides and colleagues followed 1,017 acute PE patients (median age, 64; 45%, women) across Germany for a median duration of 732 days after diagnosis. Pre-defined assessment visits were scheduled at 3, 12, and 24 months.

The co-primary outcomes were CTEPH and PPEI, defined as a combination of persistent or worsening clinical, functional, biochemical, or imaging parameters during follow-up.

CTEPH was diagnosed in 16 (1.6%) patients, after a median of 129 days; the estimated 2-year cumulative incidence was 2.3%.

Overall, 880 patients were evaluable for PPEI, for which the 2-year cumulative incidence was 16%. PPEI helped identify 15 of the 16 patients diagnosed with CTEPH during follow-up (hazard ratio for CTEPH vs. no CTEPH, 393).

Patients with PPEI had a higher risk of re-hospitalization and death, as well as worse quality of life compared with those without PPEI.

The authors conclude, "Our findings support systematic follow-up of patients after acute PE and may help to optimize guideline recommendations and algorithms for post-PE care."

Dr. Parth Rali, Director of Temple Health's Pulmonary Embolism Response Team in Philadelphia, commented on the study in an email to Reuters Health, "Post-PE impairment is real. A patient's journey does not end with acute PE. These patients need long-term follow up and further work-up to make sure they are not developing post-PE syndrome/impairment. The study highlights the need for disease awareness from both the provider's and patient's perspective."

"At Temple, we recently... showed that 1 in 5 patients coming to pulmonary clinic after PE has a new cardio-pulmonary diagnosis and 1 in 5 needs a new form of treatment, beyond the treatment for PE," he noted. (https://bit.ly/3wyqqOJ) "It shows that patients with PE may have undiagnosed medical conditions that need equal attention/awareness and work-up."

Dr. Louis Vizioli, a pulmonary, critical care and internal medicine physician at White Plains Hospital Physician Associates in New York, also commented by email. "The number of patients utilized in the FOCUS group, as well as the follow-up over several years, make the study very compelling. The data do indicate that one should be following a protocol post-PE and be wary of certain signs and symptoms. Doing so...makes good clinical sense and would probably help a number of patients. It would also help reduce readmission and improve quality-of-life issues."

The study is sponsored by the University Medical Center of the Johannes Gutenberg University in Mainz. The university received a grant from Bayer AG.

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