Missed opportunities: lower rehabilitation offers to women after pulmonary embolism
A Kronsell, N F J Nina Foens Johnsen, M E C Mohamad El Chouli, N N Nina Nouhravesh, T K Thomas Kumler, M L Morten Lamberts, D M Daniel Moelager, M S Morten Schou, G G Gunnar Gislason, C S P Caroline Sindet PedersenAbstract
Background
The incidence of PE (pulmonary embolism) is rising.1 As post-PE syndrome, PE can result in substantial persistent physical and psychological sequelae, including dyspnoea, reduced functional capacity, as well as anxiety and depression2. Yet there is still no systematic rehabilitation plan with clear follow-up guidelines for these patients. The lack of understanding extends to both healthcare providers and patients, potentially leading to inconsistent offers and unmet needs.1
Purpose
To identify gaps in availability of rehabilitation offers for PE patients, and to evaluate the alignment between patients’ rehabilitation needs and current offers.
Methods
This study is based on data from a nationwide survey of patients with PE combined with data from the Danish Nationwide registries. The questionnaire was distributed to a cohort of patients diagnosed with PE between January 1, 2020, and September 30, 2022, and reached a response rate of 60%. Baseline characteristics and analyses are stratified according to rehabilitation offers and sex.
Results
In total 4,117 patients were included in the study (female: 1,844 (44.8%)) and 2,408 (58%) patients were offered rehabilitation after PE, of whom 1,001 (41.6 %) were women. In patients that had received rehabilitation, women were older than men (median age 73 (IQR: 62, 79) vs. 68 years (IQR: 59, 76), p<0.05), had a lower income level (yearly income, median 31,388 EUR (IQR: 25,331, 41,805) vs. 37,998 EUR (IQR: 28,421, 51,038), p<0.05) and used psychotropic drugs more frequently (19.2% vs. 11.7%, p<0,05). However, men had a higher prevalence of deep venous thrombosis (24.2% vs. 17.5%, p<0,05), heart failure (6.7% vs. 4.3%, p: 0,01) and liver disease (3.3% vs. 1.8%, p: 0,03). Compared to women, men were more frequently offered advice on how to return to work (10.0% vs. 5.9%), psychological support (5.8% vs. 4.7%), education about psychological reactions (4.5% vs. 2.9%) (figure 1). In total 1,709 patients were not offered rehabilitation of whom 843 (49.3%) were women. When assessing the patient rehabilitative needs, men more frequently wanted advice regarding physical exercise (54.0% vs. 51.8%) whereas more women wanted advice regarding psychological support (41.6% vs. 34.0%) and education about psychological reactions (47.8% vs. 41.4%) (figure 2).
Conclusion
This study shows a significant gap in understanding the patient’s rehabilitation needs and the availability of suitable interventions. We find a difference between men and women in offers and needs of rehabilitation. Overall, more men receive rehabilitation, but both sexes wish to receive more offers and support than they had been given. These findings emphasize the importance of investigating sex differences incl. the possibility of constructing specific rehabilitation offers for men and women.For image description, please refer to the figure legend and surrounding text.For image description, please refer to the figure legend and surrounding text.