The vulnerable elders Survey-13 scale is superior to the simplified pulmonary embolism score index in predicting post-pulmonary embolism dyspnea in elderly survivors of acute pulmonary embolism

Abstract Introduction Post-pulmonary embolism syndrome (PPES) is an emerging phenomenon and a major complication of acute pulmonary embolism (APE). The pathogenesis of PPES is complex and multifactorial, and involves clinical, laboratory, and echocardiographic findings. A major component of PPES is persistent dyspnea, along with other symptoms such as fatigue, chest pain, lightheadedness, and/or syncope, persisting for more than 3-months after APE. Despite extensive research on PPES, there is a limited understanding of its course and management in the elderly population. The Vulnerable Elders Survey (VES-13), a tool used to identify health impairment risks, is specifically employed for patients aged≥ 60 years. Aim This study aimed to identify elderly survivors of APE who are at a higher risk of developing PPES, thereby guiding more targeted interventions. Patients and methods This study included 241 patients aged ≥60 years who were diagnosed with APE. All patients with APE were diagnosed and managed according to the European Society of Cardiology (ESC) guidelines, presented with dyspnea at admission, and were followed up for at least 3-months after discharge. Clinical evaluation, biochemical tests, the VES-13 score, and transthoracic echocardiography (TTE) were evaluated at baseline. After 3-months period, the routine evaluation of persistent dyspnea was assessed during the follow-up visit in the outpatient clinic. The primary endpoint was dyspnea 3-months after the acute episode. Results A total of 179 patients were included. Persistent dyspnea was observed in 42 subjects (23,4%). There were no significant differences in age, sex and BMI between the groups. Patients with persistent dyspnea after 3-months, as compared to patients without dyspnea, were significantly characterized as follows: -Higher VES-13 score [median 5.5 (2;10) vs. 1 (0;4) score] -Longer length of stay [median 9 (6;16) vs. 6 (5;9) days] -Higher sPESI scores [median 2 (1;2.5) vs. 1 (0;2) points] -Lower TAPSE/PASP [median 0.44 (0.25;0.7) vs. 28 (25.4;30.9) mm/mmHg]. -Higher urea concentrations [median 42.4 (35.3;67.8) vs 0.56 (0.38;0.76) mg/dl] -Higher neutrophil-to-lymphocyte ratio (NLR) [median 5.5 (3;8.2) vs. 3.7 (2.6;6.3] ) Logistic regression analysis identified the VES-13 score and NLR as significant independent risk factors for 3-month mortality (the regression model included. sPESI, VES-13 score (points), length of stay (days), urea level (mg/dl), NLR, TAPSE/PASP, Norton scale (points), Barthel scale (points), Activities of Daily Living (ADL, points), and coronary artery disease. Conclusions The VES-13 score could be particularly valuable in predicting dyspnea 3-months after APE. Elderly survivors of APE with higher baseline VES-13 scores should be closely monitored after discharge. This proactive approach can help identify patients at a greater risk of developing persistent dyspnea, enabling timely intervention and potentially improving outcomes.