Acute pulmonary embolism - aspects of respiratory symptoms and physical activity

Abstract: Introduction. Pulmonary embolism (PE) is the third most common cardiovascular disease, after myocardial infarction and stroke. Post-PE syndrome, which is characterized by long-term consequences of PE with persistent dyspnea and decreased functional capacity, has been acknowledged as a risk in the aftermath. There is an absence of knowledge about respiratory symptoms and their association with physical activity. Knowledge of patients’ experiences and healthcare professionals’ (HCPs) conceptions about respiratory symptoms and their impact on physical activity after PE are limited. The overall aim of this thesis was to cross sectionally, longitudinally and qualitatively describe, evaluate, and explore respiratory symptoms and physical activity in patients with acute PE, as well as to describe HCPs’ conceptions of respiratory symptoms and physical activity. Methods. In study I (n= 50) and II (n= 64) patients with PE rated respiratory symptoms and physical activity levels and performed measurements of lung function and functional capacity at discharge (study I), and at discharge, 3, 6 and 12 months after discharge (study II). Measurements were compared to reference values for lung function and functional capacity, as well as over time. In study III (n=14) and IV (n=21) qualitative interviews were conducted with patients with PE and HCPs. Study III sought the patients’ experiences of respiratory symptoms and their impact on physical and social activities in the aftermath. Study IV sought for HCPs’ conceptions of respiratory symptoms and physical activity in patients with PE during in-hospital care. Main results. Study I indicated that patients with PE have reduced lung function and reduced functional capacity compared to reference values, and many experienced respiratory symptoms at discharge. In study II, median hours of physical activity per week increased, while ratings of respiratory symptoms decreased during the year. Lung function increased between discharge and 3 months and functional capacity increased during the whole year. In study III the findings revealed that respiratory symptoms affected many aspects of life for the participants, illustrated by an overall theme: “Whole life changed”. The results implied that patients with PE need support from the healthcare system to manage psychological and physical symptoms in the aftermath. Study IV provided new knowledge about the complexity of management of patients with PE and respiratory symptoms. The patient group was conceived as heterogenous with different needs for information given at the right time. Structural prerequisites and personal issues affected the ability of HCPs to give correct information. Conclusions and clinical implications. The results of this thesis indicate that patients with PE are affected in many ways by their respiratory symptoms. Respiratory symptoms seem to have the greatest impact physically during the first three months after discharge and it is important to identify patients with persisting respiratory symptoms before discharge. The experience that their “whole life changed” after PE indicate that patients need support from the healthcare system to manage both physical and psychological symptoms. The patient group was conceived by HCPs as a heterogenous group with individual needs for information during in-hospital care, and prerequisites of providing the right information were identified. Overall, the need for a rehabilitation program focusing on both physical and psychological aspects of managing life after PE is supported by the results of this thesis.