Anxiety and quality of life in the acute and post-acute phase after venous thromboembolism

Introduction Venous thromboembolism (VTE) is associated with various short- and long-term complications, including psychological distress and deterioration of quality of life. We aimed to describe self-reported anxiety and generic quality of life from diagnosis up to three months after VTE.

Method We conducted a prospective cohort study including unselected VTE patients within 21 days of diagnosis at a tertiary care center. Patients with anticoagulation at the time of diagnosis were excluded. After three months, patients underwent a follow-up visit incorporated into routine clinical care. Anxiety was assessed with the Patient-Reported Outcomes Measurement Information System (PROMIS) short form 8a at baseline and follow-up. Using an online tool, a standardized T-score was calculated from the raw scores, with higher values indicating a higher degree of anxiety. The reference value is derived from a general population, with a mean of 50 and a standard deviation of 10. Quality of life was assessed with the EuroQoL Group 5-Dimension 5-Level (EQ-5D-5L) questionnaire and visual analogue scale (VAS). Based on a reference value set, answers from questions dealing with five dimensions were integrated into an overall index ranging from -0.661 to 1. For both index and visual analogue scale, higher values indicate better quality of life.

Results We included 321 patients with a median (interquartile, IQR) age of 55.6 (43.4-66.1) years; 138 (43.0%) were women. Nearly 50% of all patients had pulmonary embolism, median (IQR) BMI was 27.7 (24.4-31.4) kg/m², 91 (28.3%) reported a history of VTE, and 79 (24.6%) reported a history of cardiovascular or pulmonary disease. At baseline, 301 patients with available data had a mean (standard deviation) anxiety T-score of 51.1 (9.3). After three months, anxiety T-score improved to 46.8 (9.1), reflecting a mean change of -4.1 from baseline (data available for 254 patients). However, 60 patients (23.6% of patients with available data) reported increased levels of anxiety at three months ([Fig. 1]). Median (IQR) EQ-5D-5L index for 312 patients at baseline was 0.85 (0.68-0.92). At follow-up, data was available for 263 patients, with a median (IQR) of 0.90 (0.88-1.00). Overall, 17.8% reported a decrease in quality of life compared to baseline. Regarding VAS, median (IQR) values at baseline and follow-up were 70 (50-80) and 80 (70-90), respectively ([Fig. 2]; data available for 307 and 262 patients, respectively). Similar to the index, 46 patients (17.8%) reported a decreased quality of life compared to baseline.

Fig. 1 Intraindividual change in T-score of PROMIS anxiety short form 8a from baseline to follow-up; Higher values indicate a higher degree of anxiety. Every patient is represented by points and a connecting line. Patients depicted in red reported worsening of anxiety throughout follow-up (T-score change≥1).

Fig. 2 EQ-5D-5L dimensions (upper panel) and visual analogue scale (lower panel) at baseline (blue); For dimensions, higher values indicate more problems. For visual analogue scale, higher values indicate better health. Dimension are presented as means, visual analogue scale values as median (bold line), third and first quartile (upper and lower hinge, respectively), and outliers (points).

Conclusion During the three months following a VTE diagnosis, self-reported anxiety and generic quality of life of patients improved overall. However, a considerable proportion of patients reported increased levels of anxiety and decreased levels of quality of life, necessitating a better understanding and further investigation of this group.

Conflict of Interest

DS, SN, and BW report no conflicts of interest. CA received personal fees for lectures and/or participation in advisory boards from Bayer, BMS, Daiichi-Sankyo, Pfizer, and Sanofi.

Publication History

Article published online:
26 February 2024