Characteristics of Japanese elderly patients with pulmonary arterial hypertension

Takahashi, Yukiko; Yamamoto, Keiko; Tanabe, Nobuhiro; Suda, Rika; Koshikawa, Ken; Ikubo, Yumiko; Suzuki, Eiko; Shoji, Hiroki; Naito, Akira; Kasai, Hajime; Nishimura, Rintaro; Jujo, Takayuki; Sugiura, Toshihiko; Shigeta, Ayako; Sakao, Seiichiro

doi:10.1177/2045894019873546

Cited by 6 publications

(16 citation statements)

References 21 publications

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“… 6 Similarly, a Japanese Registry on elderly patients with IPAH or hereditary PAH (HPAH) revealed that elderly patients with IPAH/HPAH showed poorer exercise capacity and impaired gas exchange, but better pulmonary hemodynamics than younger patients. 15 However, no difference in survival was detected.…”

Section: Discussionmentioning

confidence: 95%

“…Data from the COMPERA Registry revealed that the female/male ratio in 378 newly diagnosed elderly patients (>65 years old) was almost even (1.2/1), while elderly patients presented worse functional status, better hemodynamics, received less frequently a combination therapy, and presented worse survival than younger patients 6 . Similarly, a Japanese Registry on elderly patients with IPAH or hereditary PAH (HPAH) revealed that elderly patients with IPAH/HPAH showed poorer exercise capacity and impaired gas exchange, but better pulmonary hemodynamics than younger patients 15 . However, no difference in survival was detected.…”

Section: Discussionmentioning

confidence: 99%

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The impact of cardiovascular comorbidities associated with risk for left heart disease on idiopathic pulmonary arterial hypertension: Data from the Hellenic Pulmonary Hypertension Registry (HOPE)

Arvanitaki

Vrana

Boutsikou³

et al. 2022

Pulm. circ.

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Whereas younger female patients were diagnosed with idiopathic pulmonary arterial hypertension (IPAH) in 1980s, it is now frequently encountered in elderly patients with cardiovascular comorbidities (CVCs) associated with increased risk for left heart disease. We present data until November 2019 regarding specific features and clinical outcomes of IPAH population from the Hellenic Pulmonary Hypertension Registry (HOPE). Patients were divided into two groups based on the presence of ≥ or <3 CVCs, arterial hypertension, diabetes mellitus, obesity, presence of coronary artery disease, or atrial fibrillation. Overall, 77 patients with IPAH (55.1 [interquartile range, IQR: 24.1] years, 62.8% women) have been recorded. Fifteen patients (19.2%) had ≥3 CVCs, while 25 (32%) were over 65 years old. Patients with ≥3 CVCs were older, presented an almost equal female to male ratio, walked less in 6‐min walk test, and had lower mean arterial pulmonary pressure and pulmonary vascular resistance at baseline than patients with less CVCs. Fewer patients with ≥3 CVCs received PAH‐specific treatment compared to patients with less comorbidities ( n = 11 [73.3%] versus n = 58 [95.5%], p = 0.02). During a median follow‐up period of 3.8 (IQR: 2.7) years, 18 patients died (all‐cause mortality 24.3%). Male sex and older age were independent predictors of mortality and/or lung transplantation, while CVCs did not have a significant impact on clinical outcomes. In this nationwide, register‐based study, the epidemiology of IPAH involves older patients with CVCs, who seem to have less hemodynamic compromise, but worse functional impairment and are treated less aggressively with PAH pharmacotherapy.

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Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 99%

The impact of cardiovascular comorbidities associated with risk for left heart disease on idiopathic pulmonary arterial hypertension: Data from the Hellenic Pulmonary Hypertension Registry (HOPE)

Arvanitaki

Vrana

Boutsikou³

et al. 2022

Pulm. circ.

View full text Add to dashboard Cite

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“…A smaller cohort study in Japan 22 also reported better hemodynamic data and poorer exercise capacity in the elderly group than in the young group. Furthermore, this Japanese registry revealed that the percent diffusing capacity for carbon monoxide (DLCo) of elderly patients was significantly lower than that of young patients.…”

Section: Hemodynamic Profiles In Elderly Patients With Pahmentioning

confidence: 86%

Section: Hemodynamic Profiles In Elderly Patients With Pahmentioning

confidence: 99%

“…A registry in the UK and Ireland also noted a lower percentage of DLCo in elderly patients than in young patients. Takahashi et al 22 suggested that impaired gas exchange may play a role in poor exercise capacity in older patients with PH. Another possible explanation for the paradox between good hemodynamic profile and poor exercise capacity in elderly patients with PH is that their RV adaptability is worse than that of young patients.…”

Section: Hemodynamic Profiles In Elderly Patients With Pahmentioning

confidence: 99%

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Pulmonary arterial hypertension in the elderly population

Chen

Hung

Chiang

et al. 2022

Journal of the Chinese Medical Association

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Pulmonary arterial hypertension (PAH) was a disease predominantly affecting young females about 40 years ago; however, it has been increasingly diagnosed in elderly individuals. Few studies have investigated the features of elderly patients with PAH. This review provides an overview of the characteristics of elderly patients with PAH compared to young patients. The examination of the changing demographics of the population with PAH revealed that the mean age has increased over the years. In addition, the investigation into the diagnostic challenges in elderly patients with PAH revealed the difficulty in differentiating PAH from pulmonary hypertension secondary to diastolic heart failure. Moreover, it was noted that elderly patients underwent combination drug regimens less frequently and exhibited poorer treatment responses than young patients. Finally, it was found that elderly PAH patients experienced poorer survival than young patients. The differences among five survival prediction models and their applicability in predicting the prognosis of PAH patients are discussed.

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Real‐world clinical practice of pulmonary arterial hypertension in Japan: Insights from a large administrative database

Omura,

Kitahara,

Takano

et al. 2023

Pulm. circ.

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Pulmonary arterial hypertension (PAH) is a fatal disease that often occurs at an early age. In recent years, aggressive treatment with multiple drugs from the early‐stage diagnosis is expected to improve the prognosis. Indeed, a high rate of initial combination therapy and excellent treatment outcomes have been reported from specialized centers for PAH in Japan. However, information on PAH epidemiology, including non‐PAH specialized centers in Japan, is unclear. To address the above, we conducted a retrospective observational cohort study from April 2008 to September 2020 using real‐world evidence from a large‐scale administrative database (Medical Data Vision) to examine baseline characteristics, comorbidities, and treatment profiles of Japanese patients with PAH. Five hundred and eighteen patients with PAH (treatment‐naive PAH, age 67.2 ± 15.9) were identified through our comprehensive approach which combined PAH disease codes, medications, and diagnostic procedures. Moreover, we showed that a larger proportion of patients received monotherapy in their initial treatment (66%) compared to those receiving combination therapy (34%). During the 1‐year follow‐up after PAH diagnosis, 13% of patients increased their PAH medications while other patients either decreased their PAH medications (6%) or discontinued PAH treatment (27%). The 3‐ and 5‐year event‐free survival rates of all‐cause death were 72% and 64%, respectively. This is the first large‐scale administrative database study that provides insights into real‐world PAH management in Japan. This study highlighted a different PAH clinical landscape which included a larger portion of the elderly population, higher initial monotherapy treatment, and lower survival rates than previous studies.

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Characteristics of Japanese elderly patients with pulmonary arterial hypertension

Cited by 6 publications

References 21 publications

The impact of cardiovascular comorbidities associated with risk for left heart disease on idiopathic pulmonary arterial hypertension: Data from the Hellenic Pulmonary Hypertension Registry (HOPE)

The impact of cardiovascular comorbidities associated with risk for left heart disease on idiopathic pulmonary arterial hypertension: Data from the Hellenic Pulmonary Hypertension Registry (HOPE)

Pulmonary arterial hypertension in the elderly population

Real‐world clinical practice of pulmonary arterial hypertension in Japan: Insights from a large administrative database

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