Fatigue after pulmonary embolism-prevalence and predictors

Pulmonary embolism (PE) is a common condition with negative long-term consequences such as reduced quality of life. However, there is little knowledge regarding fatigue after PE. The aim of this study was to determine prevalence and predictors of fatigue after PE.

The Lungenembolie Augsburg (LEA) study includes patients treated for acute PE at the University Hospital of Augsburg, Germany. Patients were interviewed during hospitalization and received postal questionnaires after 3 and 12 months. Fatigue was assessed using the Fatigue Assessment Scale (FAS). Data from the "Stroke Cohort Augsburg (SCHANA)" study and the "Metabolism, Nutrition and Immune System in Augsburg (MEIA)" study were used to compare fatigue prevalence after PE with that after stroke and in the general population. Multiple linear regression models were built to identify baseline predictors for fatigue 3 and 12 months after PE.

Three months after PE, the age-sex-standardized fatigue prevalence was 40.76% [95% confidence interval (CI): 24.81%-56.71%] and 12 months after PE it was 32.36% (95% CI: 20.72%-44.01%), which was significantly higher than in the general population (12.68%; 95% CI: 9.75%-15.61%), but did not significantly differ from the prevalences found in patients with stroke (3 months: 30.97% (95% CI: 22.73%-39.22%); 12 months: 28.02% (95% CI: 17.49%-38.55%). Multiple linear regression models revealed that gender modified the relationship between depression at baseline and fatigue 3 and 12 months after PE. In men, Hospital Anxiety and Depression Scale (HADS) Depression score (β = 1.92, p < 0.0001) as well as school education >9 years (β = -3.72, p = 0.0491) and in women, HADS Depression score (β = 0.80, p = 0.0057), were significantly associated with fatigue 3 months after PE. Twelve months after PE, HADS Depression score (β = 1.69, p < 0.0001) and school education >9 years (β = -5.28, p = 0.0059) were significantly associated with fatigue in men.

The results show that fatigue is common after PE. Early screening for depression and fatigue in both men and women should be considered. Lower school education level in men was shown to be a predictor of fatigue and should be taken into account when screening patients.