Prognostic and aetiological factors in chronic thromboembolic pulmonary hypertension

Condliffe, Robin; Kiely, David G.; Gibbs, J. Simon R.; Corris, Paul A.; Peacock, AJ; Jenkins, David P.; Goldsmith, Kimberley; Coghlan, J G; Pepke‐Zaba, Joanna

doi:10.1183/09031936.00092008

Cited by 161 publications

(129 citation statements)

References 22 publications

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“…The costs related to CTEPH included treatment costs, surgery and drug therapy. Assuming that 50.3% of CTEPH patients required pulmonary endarterectomy [28] with a unit cost of £7,824, and follow-up costs of £1,348 per month, the total average cost for CTEPH treatment was estimated at £5,285 for the first month, and £1,348 for the following months. The long-term impact of ICH resulting in disability was categorised as mild, moderate, and severe for both the care centre costs and home care costs.…”

Section: Methodsmentioning

confidence: 99%

Cost-effectiveness of edoxaban compared to warfarin for the treatment and secondary prevention of venous thromboembolism in the UK

Clay

Jamotte

Verhamme

et al. 2018

Journal of Market Access & Health Policy

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Background: Venous thromboembolism (VTE), which includes pulmonary embolism (PE) and deep vein thrombosis (DVT), is the third most common acute cardiovascular disease and represents an important burden for patients and payers.Objective: The aim was to estimate the cost-effectiveness of edoxaban, a non-VKA oral anticoagulant vs. warfarin, the currently most prescribed treatment for VTE in the UK.Study design: A Markov model was built using data from the Hokusai-VTE randomised controlled trial to estimate the lifetime costs and quality-adjusted life years (QALYs) in patients with VTE treated with edoxaban or warfarin over a lifetime horizon, from the UK National Health Services perspective. The model included VTE recurrences, VTE-related complications (post-thrombotic syndrome and chronic thromboembolic pulmonary hypertension), and several types of bleeds associated with anticoagulation treatment. Patients were treated during a period of 6 months after the first VTE event, followed by flexible treatment duration (from 6 months to lifetime) after recurrence, i.e., tertiary prevention.Results: Edoxaban was found dominant vs. warfarin with 0.033 additional QALY and £55 less costs. The reduction of patient management costs, specifically monitoring costs, outweighed the higher drug costs. Edoxaban was dominant in all subgroups (index DVT only, all PE cases (PE with or without DVT), PE without DVT and PE with DVT). Cost-savings ranged from £54 to £81 while additional QALYs ranged from 0.031 to 0.046. Edoxaban was found dominant in 88.6% of cases and cost-effective in additional 10.9% of cases considering a £20,000 threshold in the probabilistic sensitivity analysis.Conclusion: Edoxaban may improve patients’ quality of life in a lifetime horizon without additional costs for the healthcare system due to lower bleeding risk and no monitoring cost compared to warfarin.

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Section: Methodsmentioning

confidence: 99%

Cost-effectiveness of edoxaban compared to warfarin for the treatment and secondary prevention of venous thromboembolism in the UK

Clay

Jamotte

Verhamme

et al. 2018

Journal of Market Access & Health Policy

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“…Other established risk factors include myeloproliferative disorders and inflammatory bowel disease [2]. CTEPH registries in the UK and the prospective European CTEPH Registry have the potential to characterise CTEPH patients further [18,19]. Additional epidemiological studies in patients surviving a pulmonary embolism are also required.…”

Section: Diagnosis Of Ctephmentioning

confidence: 99%

Diagnostic testing to guide the management of chronic thromboembolic pulmonary hypertension: state of the art

Pepke‐Zaba¹

2010

Eur Respir Rev

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Chronic thromboembolic pulmonary hypertension (CTEPH) is a life-threatening and debilitating disease affecting up to 5% of survivors of pulmonary embolism. Diagnostic testing is important to distinguish it from other forms of pulmonary hypertension and to assess the feasibility of pulmonary endarterectomy.This review provides an up-to-date perspective on the diagnosis and assessment of the disease. Patients with CTEPH often have a history of pulmonary embolism, deep-vein thrombosis, thrombophilia, splenectomy, ventriculo-atrial shunt, inflammatory bowel disease or malignancy. Chest radiography may reveal pulmonary infarcts. CTEPH is often diagnosed as a wedge-shaped perfusion defect with normal ventilation scan during ventilation-perfusion scintigraphy, but multislice computed tomography angiography may be needed for differential diagnosis.Right heart catheterisation is required for diagnostic confirmation. Suitability for surgery is assessed by evaluating the number of obstructed vessels which could be disobliterated in the context of the pulmonary vascular resistance. Pulmonary vascular resistance that is out of proportion to evident obstructions is indicative of distal disease. Conventional pulmonary angiography, multi-slice computed tomography angiography and, potentially, magnetic resonance imaging can aid the decision to operate, but risk stratification systems are needed.In conclusion, CTEPH can be cured surgically, providing that patients are diagnosed and assessed using the appropriate techniques.

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“…An elevated measured PAWP may also be seen in CTEPH as a result of the presence of laminated clot and webs in the pulmonary arteries. 80 LVEDP measurement by left heart catheterization may be required in selected cases to avoid misclassification. 64 …”

Section: Rhcmentioning

confidence: 99%

Pulmonary Hypertension in Patients with Heart Failure and Preserved Ejection Fraction: Differential Diagnosis and Management

et al. 2016

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Abstract:The most common cause of pulmonary hypertension (PH) due to left heart disease (LHD) was previously rheumatic mitral valve disease. However, with the disappearance of rheumatic fever and an aging population, nonvalvular LHD is now the most common cause of group 2 PH in the developed world. In this review, we examine the challenge of investigating patients who have PH and heart failure with preserved ejection fraction (HF-pEF), where differentiating between pulmonary arterial hypertension (PAH) and PH-LHD can be difficult, and also discuss the entity of combined precapillary and postcapillary PH. Given the proven efficacy of targeted therapy for the treatment of PAH, there is increasing interest in whether these treatments may benefit selected patients with PH associated with HF-pEF, and we review current trial data.Keywords: pulmonary arterial hypertension, combined pre-and postcapillary pulmonary hypertension, heart failure with preserved ejection fraction, diastolic dysfunction. (Table 1) by a mean pulmonary arterial pressure (PAP) of ≥25 mmHg at right heart catheterization (RHC), with the most recent classification identifying 5 groups (Fig. 1): 2 group 1, pulmonary arterial hypertension (PAH), which can be idiopathic (IPAH) or associated with other conditions (most frequently systemic sclerosis and congenital heart disease); group 2, PH owing to left heart disease (PH-LHD); group 3, PH owing to lung disease (PH-Lung); group 4, chronic thromboembolic PH (CTEPH); and group 5, PH owing to unclear or multifactorial mechanisms. Accurate classification of disease is important in identifying the most appropriate form of therapy 3 and defining prognosis. 4 This requires a systematic approach to the evaluation of the breathless patient and an awareness of conditions associated with particular forms of PH. Pulmonary hypertension (PH) is definedThe most commonly encountered form of PH is related to left heart disease (LHD). 5,6 PH may be seen in heart failure with preserved ejection fraction (HF-pEF) and heart failure with reduced ejection fraction (HF-rEF), and its presence in HF-rEF is known to convey a poor prognosis. 7 HF-pEF accounts for approximately half of all new heart failure (HF) diagnoses. 8,9 While HF-pEF was initially believed to confer a better outcome than HF-rEF, the two conditions have equivalent morbidity and mortality. [10][11][12] The prevalence of PH-HF-pEF is unclear and varies with diagnostic criteria. Studies quote rates of between 53% and 83% (based on an echocardiographic systolic PAP [sPAP] > 35 mmHg or mean PAP > 25 mmHg at RHC). 13-15 A recent study 16 found that only 7% of heart failure (HF) patients had PH (but used an sPAP cutoff of ≥45 mmHg at echocardiography). PATHOPHYSIOLOGY OF PH-LHDPAH, PH-Lung, and CTEPH are precapillary in nature, caused by obstruction or destruction of the pulmonary arterial bed, whereas PH-LHD is thought to be primarily due to postcapillary abnormalities. 5 In patients with LHD, an increase in left ventricular (LV) and left atrial (LA) filling pressu...

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Prognostic and aetiological factors in chronic thromboembolic pulmonary hypertension

Cited by 161 publications

References 22 publications

Cost-effectiveness of edoxaban compared to warfarin for the treatment and secondary prevention of venous thromboembolism in the UK

Cost-effectiveness of edoxaban compared to warfarin for the treatment and secondary prevention of venous thromboembolism in the UK

Diagnostic testing to guide the management of chronic thromboembolic pulmonary hypertension: state of the art

Pulmonary Hypertension in Patients with Heart Failure and Preserved Ejection Fraction: Differential Diagnosis and Management

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