PAH disease burden ‘significant’

Jul 15 2014

By Laura Cowen, medwireNews Reporter

Patients with newly diagnosed pulmonary arterial hypertension (PAH) have a substantial burden of disease, with more than half hospitalised during the first 3 years post-diagnosis, research shows.

“Mean total hospital days in the year after first admission (inclusive of first admission)[…] was 15.3 days (median 7.0 days), which represents a significant burden for both the healthcare system as a whole and for individual patients”, report Charles Burger (Mayo Clinic, Jacksonville, Florida, USA) and colleagues in Chest.

Of the 862 patients included in the study, 490 (56.8%) had at least one hospitalisation during the 3-year follow-up period. Approximately half (52.4%) of these were PAH-related, while 43.7% were unrelated to PAH and 3.9% were for undetermined causes.

The patients were all enrolled in the Registry to EValuate Early And Long-term PAH Disease Management (REVEAL) and had newly diagnosed World Health Organization group 1 PAH.

“Our findings clearly demonstrate that all-cause hospitalization is very common among newly diagnosed patients”, Burger and co-authors remark.

“In particular, the rate of PAH-unrelated hospitalizations in this REVEAL cohort is relatively high, suggesting that the term ‘PAH-unrelated’ is a misnomer and that this category of hospitalization actually reflects a degree of risk conferred by the PAH comorbidity”, they add.

Congestive heart failure and placement or removal of a central venous catheter were the two most common causes of first-time PAH-related admissions, cited in 31.5% and 24.5% of cases, respectively. Initial intravenous line insertion (11.7%), representing initiation of intravenous therapy, escalation of PAH therapy (8.9%) and catheter infection (8.2%) were also common reasons for first-time hospitalisation.

PAH-unrelated infections, pneumonia, surgery/procedures and haemorrhage were the most common causes of PAH-unrelated hospitalisation, cited in 21.1%, 15.9%, 11.2% and 8.9% of cases, respectively.

In-hospital mortality was significantly higher for PAH-related hospitalisations than for PAH-unrelated hospitalisations, at 5.4% versus 1.4%, while 3-year survival among those discharged alive was significantly lower, at 56.8% versus 67.8%.

The researchers found that patients who were hospitalised for any reason had a higher prevalence of comorbidity and more severe PAH at enrolment, as measured by functional class, pericardial effusion, mean right atrial pressure, cardiac index and REVEAL risk score, than patients who were not hospitalised.

There were fewer differences between patients with PAH-related and PAH-unrelated hospitalisations, but patients with PAH-related hospitalisations did have more severe PAH at the time of first admission.

“The lack of differences between the PAH-related and PAH-unrelated groups at enrollment is an important point, given our finding that both in-hospital and post-discharge survival are significantly worse for patients hospitalized for PAH-related reasons, despite the similar frequencies at which PAH-related and PAH-unrelated hospitalizations occur”, Burger et al remark.

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