Primary cardiac hospitalizations in pulmonary arterial hypertension: Trends and outcomes from 2001 to 2014

Harder, E.; Small, Aeron; Fares, Wassim H.

doi:10.1016/j.rmed.2019.105850

Cited by 18 publications

(15 citation statements)

References 38 publications

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“… 16 , 18 We expected a higher mortality rate such as the usually described during hospitalizations for noncardiovascular conditions in PH patients. 2 …”

Section: Discussionmentioning

confidence: 99%

The impact of COVID‐19 pandemic on pulmonary hypertension: What have we learned?

et al. 2022

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The coronavirus 2019 disease (COVID‐19) pandemic threatened the Spanish health‐care system. Patients with demanding conditions such as precapillary pulmonary hypertension (PH) faced a potentially severe infection, while their usual access to medical care was restricted. This prospective, unicentric study assessed the impact of COVID‐19 on PH patients' outcomes and the operational changes in the PH network. Sixty‐three PH patients (41 pulmonary arterial hypertension [PAH]; 22 chronic thromboembolic pulmonary hypertension [CTEPH]) experienced COVID‐19. Overall mortality was 9.5% without differences when stratifying by hemodynamics or PAH‐risk score. Patients who died were older (73.6 ± 5 vs. 52.2 ± 15.4; p = 0.001), with more comorbidities (higher Charlson index: 4.17 ± 2.48 vs. 1.14 ± 1.67; p = 0.0002). Referrals to the PH expert center decreased compared to the previous 3 years (123 vs. 160; p = 0.002). The outpatient activity shifted toward greater use of telemedicine. Balloon pulmonary angioplasty activity could be maintained after the first pandemic wave and lockdown while pulmonary thromboendarterectomy procedures decreased (19 vs. 36; p = 0.017). Pulmonary transplantation activity remained similar. The COVID‐19 mortality in PAH/CTEPH patients was not related to hemodynamic severity or risk stratification, but to comorbidities. The pandemic imposed structural changes but a planned organization and resource reallocation made it possible to maintain PH patients' care.

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“… 16 , 18 We expected a higher mortality rate such as the usually described during hospitalizations for noncardiovascular conditions in PH patients. 2 …”

Section: Discussionmentioning

confidence: 99%

The impact of COVID‐19 pandemic on pulmonary hypertension: What have we learned?

et al. 2022

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“…This supplements some existing literature which showed that PAH was not associated with increased 30-day mortality in patients admitted for sepsis (odds ratio 0.93, 95% confidence interval (CI) 0.59–1.44) [ 9 ]. In a non-comparative study, sepsis was identified as the most common cause of non-cardiac-related hospitalizations (25%) for patients with PAH [ 14 ]. It was also reported that mortality in patients with PAH was worse when admitted for non-cardiac causes versus a primary cardiac hospitalization (6.9 vs. 5.3%).…”

Section: Discussionmentioning

confidence: 99%

Hospital outcomes for patients with pulmonary arterial hypertension in sepsis and septic shock

et al. 2022

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Background Pulmonary arterial hypertension (PAH) is associated with increased morbidity and mortality risk. The risk for adverse outcomes in patients with PAH in sepsis or septic shock (SSS) is uncertain. Methods Adult patients diagnosed with SSS were identified in the National Readmissions Database over the years 2016–2017. A 2:1 ratio nearest propensity matching method was employed for several demographic, social, and clinical variables. In-hospital outcomes were compared between patients with PAH and those without, using t-test and chi-squared test as appropriate. Patients with cardiogenic shock were excluded. Relevant ICD-10 codes were used, and statistical significance was set at 0.05. Results A total of 1,134 patients with PAH and sepsis/septic shock were identified, with a mean age of 65 years and 67% identifying as females. Patients with PAH had a higher prevalence of some chronic conditions, including chronic pulmonary disease, renal failure, congestive heart failure, coronary artery disease, obesity, coagulation disease. The prevalence of type 2 diabetes mellitus and alcohol use was lower in this cohort. After matching, patients with PAH and SSS, when compared to those with SSS and without PAH, had an increased occurrence of acute heart failure (24.1% vs. 19.6%, p = 0.003), amongst clinical outcomes. The differences in the occurrence of death, vasopressor use, paroxysmal atrial fibrillation, acute myocardial infarction, acute kidney injury, and stroke outcomes were not statistically different between the two groups. Patients with PAH, however, had a longer hospital stay (13.5 days vs. 10.9 days, p < 0.001) and hospital costs ($164,252 vs. $129,185, p < 0.001). Conclusion Patients with PAH have worse outcomes for acute heart failure in sepsis or septic shock. Other mortality and morbidity outcomes are not statistically different. PAH is also associated with a longer hospital stay and increased hospital costs. These findings should be interpreted recognizing the inclusion of patients with re-admissions and the administrative nature of the database.

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“…In fact, some experimental treatments tested for PAH such as recombinant ACE2, synthetic vasoactive intestinal peptide or IL-6 antagonists are already being tested in clinical trials for COVID-19 pneumonia, which support the hypothesis of pathophysiological similarities between both conditions [ 75 ] ( Table 1 ). This makes this population extremely vulnerable to acute conditions, especially to those causing severe respiratory failure [ 11 ]. In fact, infectious conditions are a common cause of decompensated right heart failure and death in these patients [ 74 ].…”

Section: Pulmonary Hypertension: a Paradigm Of Endothelial Dysfuncmentioning

confidence: 99%

“…The resultant increased pulmonary arterial pressures in PAH and CTEPH contribute to a further increase of the right ventricular afterload, thus leading to right ventricular dysfunction and reducing survival among affected patients, being heart failure the most common cause of death [ 10 ]. Hospitalizations for cardiovascular and non-cardiovascular diseases are common in these groups of patients and carry a high mortality risk, being especially high in patients admitted to the intensive care unit [ 11 , 12 ].…”

Section: Introductionmentioning

confidence: 99%

Effect of Coronavirus Disease 2019 in Pulmonary Circulation. The Particular Scenario of Precapillary Pulmonary Hypertension

et al. 2020

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The Coronavirus Disease of 2019 (COVID-19) has supposed a global health emergency affecting millions of people, with particular severity in the elderly and patients with previous comorbidities, especially those with cardiovascular disease. Patients with pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH) could represent an especially vulnerable population because of the high mortality rates reported for respiratory infections. However, the number of COVID-19 cases reported among PAH and CTEPH patients is surprisingly low. Furthermore, the clinical picture that has been described in these patients is far from the severity that experts would expect. Endothelial dysfunction is a common feature between patients with PAH/CTEPH and COVID-19, leading to ventilation/perfusion mismatch, vasoconstriction, thrombosis and inflammation. In this picture, the angiotensin-converting enzyme 2 plays an essential role, being directly involved in the pathophysiology of both clinical entities. Some of these common characteristics could explain the good adaptation of PAH and CTEPH patients to COVID-19, who could also have obtained a benefit from the disease’s specific treatments (anticoagulant and pulmonary vasodilators), probably due to its protective effect on the endothelium. Additionally, these common features could also lead to PAH/CTEPH as a potential sequelae of COVID-19. Throughout this comprehensive review, we describe the similarities and differences between both conditions and the possible pathophysiological and therapeutic-based mechanisms leading to the low incidence and severity of COVID-19 reported in PAH/CTEPH patients to date. Nevertheless, international registries should look carefully into this population for better understanding and management.

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Primary cardiac hospitalizations in pulmonary arterial hypertension: Trends and outcomes from 2001 to 2014

Cited by 18 publications

References 38 publications

The impact of COVID‐19 pandemic on pulmonary hypertension: What have we learned?

The impact of COVID‐19 pandemic on pulmonary hypertension: What have we learned?

Hospital outcomes for patients with pulmonary arterial hypertension in sepsis and septic shock

Effect of Coronavirus Disease 2019 in Pulmonary Circulation. The Particular Scenario of Precapillary Pulmonary Hypertension

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