Electronically Delivered Home Rehabilitation to Improve Symptoms and Activity After Pulmonary Embolism - This proposed Mentored Patient-Oriented Research Career Development Award will support Dr. Lachant’s advancement as a physician-scientist equipped to conduct independent research which sensibly utilizes emerging wearable technology and rehabilitation strategies to improve the lives of patients with heart and lung disease. The research project itself will study the impact of an electronically-delivered rehabilitation program early after hospitalization for acute pulmonary embolism. The proposed research study will build on a foundation of didactic coursework and provide an opportunity for mentored development in clinical trial design and execution. A key training goal will be to develop and automate analysis of novel end points using wearable technology (heart rate and activity); he will also gain expertise in biostatistics, management and analysis of massive data sets, and the role of exercise in disease. Completion of this award will allow Dr. Lachant to become an independent researcher performing decentralized clinical trials incorporating wearable devices in pulmonary vascular disease towards the goal of delivering optimal home rehabilitation programs. Residual dyspnea (Post-PE Syndrome) is common (~50%) after acute PE and is associated with increased morbidity and healthcare utilization. Exercise after acute pulmonary embolism is generally recommended in the 2019 European Society of Cardiology guidelines without any details (appropriate location, degree of intensity, type of monitoring). Dr. Lachant’s hypothesis is that an early rehabilitation program incorporating heart rate monitoring will reduce post PE syndrome by addressing deconditioning and anxiety, two factors associated with Post-PE syndrome. To test this hypothesis, Dr. Lachant will enroll patients hospitalized with acute pulmonary embolism into an electronically-delivered rehabilitation program within seven days of discharge. We will evaluate whether a prescriptive exercise program which gradually intensifies over 8 weeks is better than regular electronic contact to decrease Post-PE syndrome. Since Post-PE syndrome does not have a diagnostic test, he will evaluate multiple parameters as surrogates for Post-PE syndrome, including an end point combining a change in activity with a reduction in PEmb quality of life questionnaires (Aim 1). The optimal activity tracker wear time and exercise compliance will also be evaluated (Aim 2). We will be intentionally inclusive in our recruitment and seek to determine whether sex, race/ethnicity, or socioeconomic factors associate with outcomes or participation. The study results will provide invaluable data for Dr. Lachant to design a multicenter, prospective study implementing a decentralized, home-based rehabilitation after hospitalized acute PE. His project mentors are experts in exercise and rehabilitation (Karen Mustian, Ph.D, MPH) and pulmonary vascular disease (R. James White, MD, Ph.D); experts in pulmonary embolism clinical trials (Jeffrey Kline, MD) and Biomedical Engineering (Jean Pierre Couderc Ph.D) will assist with key training goals. This accomplished mentor team will help support his launch as an independent investigator.
