Hospitalizations of Idiopathic Pulmonary Arterial Hypertension in the United States: A National Perspective a Decade Apart (2007 vs 2017)

Abstract

Idiopathic pulmonary arterial hypertension (IPAH) related hospitalizations contribute to morbidity, mortality and incur substantial healthcare costs. Several advances in management have been achieved over the last decade. The objective of this study is to compare hospitalization related to IPAH between 2007 and 2017 using Nationwide In-patient Sample Database (NIS).METHODS: Retrospective, observational, population-based cohort analysis. NIS is the largest and most comprehensive all-payer database of inpatient hospitalizations in the US. IPAH was identified using the ICD9-CM (416.0) and ICD-10 codes (I27.0) for 2007 and 2017 respectively. We included patients 18 years or older from the years 2007 and 2017. Total hospitalizations, demographics, primary payer, bed size, location/teaching status of the hospital, region of hospital, comorbidities, all-cause mortality, the median length of stay, and median charges were analyzed.RESULTS: IPAH diagnosis was associated with 0.05% of all hospitalizations reviewed in 2007 and 0.03% in 2017. Hospitalizations occurred mostly in females compared to males (11,542 (65.2%) in 2007 vs. 6380 (68.4%) in 2017), but latter carried a higher mortality. Whites continued to have a higher total number of hospitalizations for IPAH than other races in 2007 and 2017 (67.4% vs. 64.1%). The number of IPAH hospitalizations did decrease from 17,713 in 2007 to 9,330 in 2017 (p<0.001) with most being at large bed hospitals (2007(11,820 (66.8%)) vs. 2017( 5,665 (60.7%)). Regional variations in trends were also noted. There was no significant difference in the median length of stay between the 2 years. Medicare was the primary payer in most admissions in both years (11,931 (67.4%) in 2007 vs 5795 (62.3%) in 2017). Total all-cause mortality (IPAH Hospitalization) decreased in 2017 (4.8%) compared to 2007 (6.4%) (p<0.001). Multivariate analysis of factors associated with inpatient mortality revealed the following: Age group 45-64 (OR 2.09, P<0.001) and over 65 (OR 4.09, P < .0001) had a greater rate of mortality compared to the age group 18-44. Males had higher mortality (OR 1.18, p¼0.015) than females. Blacks (OR 0.79, p¼0.014) and Hispanics (OR 0.65, p¼0.003) had lower mortality than whites. Fewer patients had cardiac arrest in 2017 vs 2007 (145 (1%) vs 169(1.6%)) Increased risk of death in the event of cardiac arrest was noted (OR 27.22, p<0.001) Total charges in United States Dollars (USD) increased substantially in 2017 compared to 2007 ($26,016 vs. $46,450). CONCLUSIONS: NIS based hospitalization data comparing 2007 to 2017 revealed the following findings:1. Significant reduction in IPAH related hospitalizations2. Reduced all-cause mortality related to hospitalization3. Increased healthcare costs CLINICAL IMPLICATIONS: IPAH is linked to an increased risk of morbidity and mortality. Further epidemiological studies are needed to understand the nuances in IPAH related hospitalizations and outcomes.

Economic burden of illness among patients with pulmonary arterial hypertension (PAH) associated with connective tissue disorders (CTD)

“…The present study findings have important implications given the trends in PAH care observed in previous studies using the US Nationwide Inpatient Sample Database (NIS) 17,19 . In one study using US NIS data from 2001 to 2012, 17 the rate of PAH‐related hospitalizations was found to have decreased over time, which may reflect improvements in the standard of care for PAH.…”

“… 17 A similar decrease in hospitalization rates accompanied by rising costs was observed among patients with iPAH in another study using US NIS from 2007 to 2017. 19 In light of these previously reported trends, along with the substantial cost impact observed in the present study, there is a continued need for PAH management strategies that could address this growing burden of disease. 35 …”

“…On the other hand, hospitalization costs from a healthcare payer perspective were found to rise over time, which may be related to an increase in comorbidities among patients admitted with PAH 17 . A similar decrease in hospitalization rates accompanied by rising costs was observed among patients with iPAH in another study using US NIS from 2007 to 2017 19 . In light of these previously reported trends, along with the substantial cost impact observed in the present study, there is a continued need for PAH management strategies that could address this growing burden of disease 35…”

“…The present study findings have important implications given the trends in PAH care observed in previous studies using the US Nationwide Inpatient Sample Database (NIS). 17 , 19 In one study using US NIS data from 2001 to 2012, 17 the rate of PAH‐related hospitalizations was found to have decreased over time, which may reflect improvements in the standard of care for PAH. On the other hand, hospitalization costs from a healthcare payer perspective were found to rise over time, which may be related to an increase in comorbidities among patients admitted with PAH.…”

“…To date, several studies have reported that PAH is associated with a substantial burden in terms of healthcare resource utilization (HRU) and costs in the United States (US), 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 which may be exacerbated among patients with greater PAH severity. 22 However, there is currently limited information specific to the burden of illness among patients with CTD + PAH in the real‐world setting.…”