Symptoms Suggestive of Postpulmonary Embolism Syndrome and Utilization of Diagnostic Testing

Persistent symptoms of chest pain, dyspnea, fatigue, lightheadedness, and/or syncope more than 3 months after an acute pulmonary embolism (PE) are collectively classified as postpulmonary embolism syndrome (PPES). Although PPES is increasingly recognized as an important long-term sequel of acute PE,...

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Published in:Journal of the Society for Cardiovascular Angiography & Interventions 2023-11, Vol.2 (6), p.101063, Article 101063
Main Authors: Aggarwal, Vikas, Hyder, S. Nabeel, Kamdar, Neil, Zghouzi, Mohamed, Visovatti, Scott H., Yin, Zhe, Barnes, Geoffrey, Froehlich, James, Moles, Victor M., Cascino, Thomas, Agarwal, Prachi, Haft, Jonathan, Rosenfield, Kenneth, Qiang, Amy, McLaughlin, Vallerie V., Nallamothu, Brahmajee K.
Format: Article
Language:English
Subjects:
chronic thromboembolic disease
chronic thromboembolic pulmonary hypertension
post-PE syndrome
pulmonary embolism
pulmonary hypertension
residual pulmonary vascular obstruction
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Summary:Persistent symptoms of chest pain, dyspnea, fatigue, lightheadedness, and/or syncope more than 3 months after an acute pulmonary embolism (PE) are collectively classified as postpulmonary embolism syndrome (PPES). Although PPES is increasingly recognized as an important long-term sequel of acute PE, its contemporary incidence is unclear. Furthermore, the utilization of diagnostic testing for further phenotypic characterization of these patients is unknown. This study aimed to define the incidence of PPES and evaluate the utilization of diagnostic tests among a national cohort of patients with PE. Retrospective cohort study was performed using the national administrative database, Clinformatics DataMart Database (Optum Insight), and included adult patients (18 years or older) with no history of acute PE or pulmonary hypertension, diagnosed with acute PE between October 1, 2016, and December 31, 2018. With acute PE event as the exposure, the incidence of symptoms consistent with PPES and diagnostic test utilization among patients with PPES were evaluated. Of 21,297 incident patients with acute PE, 11,969 (56.2%) showed ≥1 symptom of PPES, which was new since their pre-PE baseline. New dyspnea was the most common and noted in 3268/15,203 (21.5%) patients, followed by new malaise or fatigue in 2894/15,643 (18.5%) patients. Among the 11,969 patients with PPES, 5128 (42.8%) received ≥1 diagnostic test, with 3242 (27%) receiving a computed tomography pulmonary angiogram, 2997 (25%) receiving an echocardiogram, and 325 (2.7%) received a ventilation-perfusion scan within 3-12 months after PE. Significantly lower use of diagnostic testing was noted in patients older than 65 years (adjusted odds ratio, 0.89; 95% CI, 0.81-0.98). Symptoms consistent with PPES are common after acute PE, occurring in more than half of the patients. Diagnostic imaging for further phenotypic characterization is used in less than half of such patients with PPES. [Display omitted] •Question: How often are patients with a history of acute pulmonary embolism experiencing persistent symptoms and subsequently undergoing diagnostic testing to evaluate for chronic complications?•Findings: In this retrospective cohort of 21,297 incident patients with a history of acute pulmonary embolism, ∼55% showed evidence of continued symptoms 3 months after their index event. Overall, utilization of diagnostic testing was low among those with persistent symptoms.•Meaning: Persistent symptoms are common after p
ISSN:2772-9303
2772-9303
DOI:10.1016/j.jscai.2023.101063