Effects of COVID-19 pandemic on the management of pulmonary hypertension

Zhou, Christine; Sahay, Sandeep; Shlobin, Oksana A.; Soto, Francisco J.; Mathai, Stephen C.; Melendres‐Groves, Lana; Mullin, Christopher J.; Levine, Deborah J.; Kay, Dana; Highland, Kristin B.; Bossone, Eduardo; Poms, Abby; Memon, Humna; Balasubramanian, Vijay; Farmer, Mary Jo S.; Rahaghi, Franck; Elwing, Jean M.

doi:10.1016/j.rmed.2022.107061

Cited by 3 publications

(1 citation statement)

References 28 publications

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“…The findings of our study quantifying the impact of care disruptions associated with the COVID‐19 pandemic are supported by the results of a survey related to the care of patients with PH completed by 95 healthcare professionals in the US Pulmonary Vascular Disease NetWork, with responses collected from November 2020 to February 2021. 11 During the pandemic, 84% of physicians used telemedicine for PH patient care (vs. 15% before the pandemic). The survey identified that access to PAH‐related tests was a major area of disruption (>90% of respondents) and around one‐third of respondents experienced disruptions with renewal/approval of medications.…”

Section: Discussionmentioning

confidence: 99%

Impact of the COVID‐19 pandemic on care disruptions, outcomes, and costs in patients receiving pulmonary arterial hypertension‐specific therapy in the United States of America: An observational study

George,

Germack,

Goyal

et al. 2023

Pulm. circ.

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Regular expert follow‐up, risk assessment, and early therapeutic intervention minimize worsening of pulmonary arterial hypertension (PAH). COVID‐19 lockdown measures were challenging for chronic disease management. This retrospective, longitudinal analysis used US claims data (January 12, 2016 to September 11, 2021) for patients treated with PAH‐specific medication to compare in‐person outpatient and specialist visits, telemedicine visits, and PAH‐related tests during 6‐month assessment periods pre‐ and immediately post‐COVID‐19. Hospitalizations, costs, and outcomes were compared in patients with and without care disruptions (no in‐person or telemedicine outpatient visits in immediate post‐COVID‐19 period). Patients in the immediate post‐COVID‐19 (N = 599) versus the pre‐COVID‐19 period (N = 598) had fewer in‐person outpatient visits (mean 1.27 vs. 2.12) and in‐person specialist visits (pulmonologist, 22.9% vs. 37.0% of patients; cardiologist, 27.5% vs. 33.8%); and more telemedicine visits (mean 0.45 vs. 0.02). In the immediate post‐COVID‐19 period, patients were less likely to have a PAH‐related test versus the pre‐COVID‐19 period (incidence rate ratio: 0.700; 95% confidence interval: 0.615−0.797), including electrocardiograms (41.7% vs. 54.2%) and 6‐minute walk distance tests (16.2% vs. 24.9%). In the immediate post‐COVID‐19 period, 48 patients had care disruptions and, in the following year, required more hospital days than those without care disruptions (N = 240) (median 10 vs. 5 days in total) and had higher overall hospitalization costs (median US$34,755 vs. US$20,090). Our findings support the need for minimizing care disruptions to potentially avoid incremental post‐disruption healthcare utilization and costs among patients with serious chronic diseases such as PAH.

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Section: Discussionmentioning

confidence: 99%

Impact of the COVID‐19 pandemic on care disruptions, outcomes, and costs in patients receiving pulmonary arterial hypertension‐specific therapy in the United States of America: An observational study

George,

Germack,

Goyal

et al. 2023

Pulm. circ.

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Epidemiology of supplemental oxygen in patients with pulmonary hypertension

Torres‐Castro,

Hinojosa,

Martínez‐Meñaca

et al. 2024

Respirology

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Background and ObjectivePatients with pulmonary hypertension (PH) may present with hypoxaemia at rest or during daily activities. There is no epidemiological data on the prescription of long‐term oxygen therapy (LTOT) in patients with PH. The study sought to analyse the prevalence and incidence of LTOT prescription among patients with pulmonary arterial hypertension (PAH) or chronic thromboembolic pulmonary hypertension (CTEPH) in Spain and to determine predictors for this prescription.MethodsA retrospective analysis was performed from the Spanish Registry of Pulmonary Arterial Hypertension (REHAP). Collected data included demographics and anthropometric measurements, functional class (FC), arterial blood gases, pulmonary function tests, haemodynamic measurements, six‐minute walking distance (6MWD) and LTOT prescription. In addition, we assessed the prevalence and incidence of LTOT prescription by PH group and subtype and potential predictors for LTOT initiation in the first 5 years after diagnosis.ResultsWe analysed 4533 patients (69.9% PAH and 30.1% CTEPH), mostly female (64.5%), with a mean age of 53.0 ± 18.3 years. The prevalence of LTOT was 19.3% for all patients. The incidence of LTOT prescriptions decreased from 5.6% to 1.6% between 2010 and 2019, respectively. Predictors for LTOT prescription, excluding those that represent the indication for oxygen therapy were: FC (HR: 1.813), 6MWD (HR: 1.002), mean pulmonary arterial pressure (mPAP) (HR: 1.014), cardiac index (CI) (HR: 1.253), pulmonary vascular resistance (PVR) (HR: 1.023) and diffusing capacity of carbon monoxide (DLCO) (HR: 1.294).ConclusionThe prevalence of LTOT in PAH and CTEPH patients is close to 20%. FC, 6MWD, mPAP, CI, PVR and DLCO were predictors for LTOT prescription.image

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Differential impact of the pandemic first wave on chronic respiratory diseases in France

Fartoukh,

Brolon,

Rahmoun

et al. 2024

Preprint

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Background. The COVID-19 pandemic has been associated with dramatic changes in the management of patients with chronic respiratory diseases (CRD), resulting in varying clinical profile and use of healthcare services of patients hospitalised. Patients and Methods. Using the French national hospital database, we analysed changes in epidemiological profile, clinical presentation at hospital referral and outcomes (ICU admission and in-hospital mortality) of CRD patients hospitalised for COVID-19 during the first wave of the pandemic in France. Results. Non-interstitial CRD and pulmonary vascular diseases (PVD) were the most prevalent CRDs (95%). The part of CRD patients among the total inpatients was substantial, decreasing during lockdown (from 12.1% to 10.8%), then returning to the pre-lockdown level (12.4%). The CRD patients were older and comorbid males with higher rates of ICU admission and mortality, as compared with their counterparts. Half of them had a complicated clinical profile (CCP, ICU admission or death). Overall, in-hospital length of stay was 9 (4-16) days and mortality rate 19.8%. These characteristics varied along time. In multivariable analyses, PVD was associated with a CCP (aORs, from 1.36; CI 1.18-1.57 to 1.82; CI 1.56-2.12) and mortality (with aHRs >1.5 in the 18-55 and 56-75 age groups). Conclusion. We report a substantial part of CRD patients hospitalised with COVID-19, characterized by a more severe initial clinical presentation and higher rates of complicated stays, with changes along time suggesting differential exposure and use of resources. The PVD subgroup was independently associated with CCP and mortality during the entire study period.

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Effects of COVID-19 pandemic on the management of pulmonary hypertension

Cited by 3 publications

References 28 publications

Impact of the COVID‐19 pandemic on care disruptions, outcomes, and costs in patients receiving pulmonary arterial hypertension‐specific therapy in the United States of America: An observational study

Impact of the COVID‐19 pandemic on care disruptions, outcomes, and costs in patients receiving pulmonary arterial hypertension‐specific therapy in the United States of America: An observational study

Epidemiology of supplemental oxygen in patients with pulmonary hypertension

Differential impact of the pandemic first wave on chronic respiratory diseases in France

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