The impact and financial burden of pulmonary arterial hypertension on patients and caregivers

Zhai, Zhenguo; Zhou, Xia; Zhang, Shuai; Xie, Wanmu; Wu, Jun; Kuang, Tuguang; Yang, Yuanhua; Huang, Hong; Wang, Chen

doi:10.1097/md.0000000000006783

Cited by 37 publications

(78 citation statements)

References 17 publications

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“…The present study indicated that the significant influencing factors of anxiety/depression were the financial situation and right ventricular enlargement. The conclusion that the financial situation as a significant influencing factor of anxiety/depression was in accordance with a previous descriptive study by our group, according to which patients with PH reported that the financial burden due to their diseases was heavy and they had emotional problems (24). It appears that the self-assessment of the mental condition and QoL by patients, together with clinical parameters determined by clinicians, may be part of a comprehensive assessment.…”

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confidence: 90%

Anxiety and depression in patients with pulmonary arterial hypertension and chronic thromboembolic pulmonary hypertension: Results from a Chinese survey

et al. 2020

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Limited studies have focused on mental symptoms (anxiety and depression) and their impact on quality of life (QoL) in patients with pulmonary hypertension (PH). The objective of the present study was to assess the prevalence of anxiety and depression and their association with QoL in patients with pulmonary arterial hypertension (PAH) and chronic thromboembolic PH (CTEPH) in a Chinese population. Patients diagnosed with PH by right heart catheterization between March 2015 and February 2016 were recruited. QoL [short form 36 Health Survey Questionnaire (SF-36)] and depression (Patient Health Questionnaire depression scale-9) and anxiety (Generalized Anxiety Disorder-7) were assessed at baseline. Patients were followed up every 3 months. A total of 36 patients with PAH and 62 patients with CTEPH were enrolled. According to the results of the clinical examination and the questionnaires for depression and anxiety, patients were divided into two groups: Group 1, with depression and/or anxiety (n=65, 66.3%) and group 2, without depression or anxiety (n=33, 33.7%). At baseline, the two groups did not differ in their hemodynamics. Patients with depression and/or anxiety (group 1) had a significantly lower score in all subscales of SF-36 (P<0.05). The impairment of QoL significantly correlated with the severity of depression (P<0.001) and anxiety (P<0.05). During the follow-up period, end-point events (death or admission due to deterioration) occurred in 17 patients (17.3%); 8 patients (8.1%) were lost to follow-up. The end-point event-free survival rate in group 2 was significantly higher than that in group 1. Multivariate logistic regression analysis suggested that the financial situation and right ventricular enlargement were influencing factors of depression and/or anxiety. In conclusion, in patients with PH from a Chinese population, anxiety and depression were frequently encountered and significantly correlated with QoL. The significant relevant factors influencing anxiety/depression were the financial situation and right ventricular enlargement and patients with depression had a worse prognosis than those without.

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confidence: 90%

Anxiety and depression in patients with pulmonary arterial hypertension and chronic thromboembolic pulmonary hypertension: Results from a Chinese survey

et al. 2020

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“…In the United States, the cost for bosentan and epoprostenol can be as much as $25,000 and $35,000 per month, respectively (Wryobeck, Lippo, McLaughlin, Riba, & Rubenfire, 2007). According to a national survey in China, over 50% of PAH patients do not use any kind of PAH‐specific therapies due to the financial burden (Zhai et al, 2017). It is thus important to develop and identify new medications that have equal or higher efficacy but are affordable, readily available, and easily administered for patients with PAH.…”

Section: Introductionmentioning

confidence: 99%

Tetramethylpyrazine: A promising drug for the treatment of pulmonary hypertension

Chen

Yang

et al. 2020

British J Pharmacology

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Background and Purpose: Tetramethylpyrazine (TMP) was originally isolated from the traditional Chinese herb ligusticum and the fermented Japanese food natto and has since been synthesized. TMP has a long history of beneficial effects in the treatment of many cardiovascular diseases. Here we have evaluated the therapeutic effects of TMP on pulmonary hypertension (PH) in animal models and in patients with pulmonary arterial hypertension (PAH) or chronic thromboembolic pulmonary hypertension (CTEPH).Experimental Approach: Three well-defined models of PH -chronic hypoxia (10% O 2 )-induced PH (HPH), monocrotaline-induced PH (MCT-PH) and Sugen 5416/hypoxia-induced PH (SuHx-PH) -were used in Sprague-Dawley rats, and assessed by echocardiography, along with haemodynamic and histological techniques. Primary cultures of rat distal pulmonary arterial smooth muscle cells (PASMCs) were used to study intracellular calcium levels. Western blots and RT-qPCR assays were also used.In the clinical cohort, patients with PAH or CTEPH were recruited. The effects of TMP were evaluated in all systems.Key Results: TMP (100 mgÁkg −1 Áday −1 ) prevented rats from developing experimental PH and ameliorated three models of established PH: HPH, MCT-PH and SuHx-PH.The therapeutic effects of TMP were accompanied by inhibition of intracellular calcium homeostasis in PASMCs. In a small cohort of patients with PAH or CTEPH, oral Abbreviations: 2D, 2-dimensional; 6MWD, 6-min walking distance; Ccr, creatinine clearance; CTEPH, chronic thromboembolic pulmonary hypertension; EIP, End-inspiratory plateau pressure; FAC, Fractional area change; H&E, haematoxylin and eosin; HPH, hypoxia-induced pulmonary hypertension; HRR1, heart rate recovery at 1 min of rest; IPAH, idiopathic pulmonary arterial hypertension; KRBS, Krebs Ringer bicarbonate solution; LV, left ventricle; LVEF, left ventricular ejection fraction; LVFS, left ventricular fractional shortening; MCT, monocrotaline; mPAP, mean pulmonary arterial pressure; PA, pulmonary artery; PAD, pulmonary arterial diameter; PAH, pulmonary arterial hypertension; PAP, pulmonary arterial pressure; PASMC, pulmonary arterial smooth muscle cells; PAT, pulmonary arterial acceleration time; PET, pulmonary arterial ejection time; PH, pulmonary hypertension; PVR, pulmonary vascular resistance; RAD, right atrium diameter; RHC, right heart catheterization; ROCC, receptor-operated Ca 2+ channels; ROCE, receptor-operated Ca 2+ entry; RV, right ventricle; RVEDD, Right ventricular end diastolic diameter; RVEDWT, right ventricular end-diastolic free-wall thickness; RVSP, right ventricular systolic pressure; S, septum; SOCC, store-operated Ca 2+ channels; SOCE, store-operated Ca 2+ entry; SuHx-PH, Sugen/hypoxia-induced pulmonary hypertension; TAPSE, tricuspid annular plane systolic excursion; TMP, tetramethylpyrazine; VDCC, voltage-dependent Ca 2+ channels. administration of TMP (100 mg, t.i.d. for 16 weeks) increased the 6-min walk distance and improved the 1-min heart rate recovery.Conclusion and Implications: Our results s...

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“…In addition, patients with PAH have significant psychological morbidity. In fact, the diagnosis of PAH creates emotional and psychological distress, reflected as feelings of frustration, anger, low self-esteem and worthlessness [25,27]. Indeed, patients with worse functional class and reduced exercise capacity often have a higher prevalence of depression [10].…”

Section: Health-related Quality Of Life In Pahmentioning

confidence: 99%

“…Worsening HRQoL in patients with PAH is associated with reduced social activity and emotional wellbeing [11]. Patients frequently face a loss of financial security and social status, as they become unable to maintain employment [10], travel obligations or social activities [25,27]. In addition, marital relationships can suffer as sexual intimacy diminishes given physical limitations, reduced self-esteem and a partner's fear of affecting the patient's condition [25].…”

Section: Health-related Quality Of Life In Pahmentioning

confidence: 99%

Palliative care in pulmonary arterial hypertension: an underutilised treatment

et al. 2018

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@ERSpublications Palliative care remains an underutilised treatment option in PAH. This article attempts to highlight its importance in the management of PAH and highlight the barriers faced by both physicians and patients in seeking palliative care.ABSTRACT Pulmonary arterial hypertension (PAH) is a condition characterised by increased pulmonary vascular resistance which can lead to right heart failure and premature death. It imposes a significant burden on patients' lives, affecting their physical, emotional and social wellbeing. Pharmacological therapies are the mainstay of treatment; while they are not curative, they can alleviate patient suffering, improve quality of life and delay disease progression. Despite these therapies, disease progresses in a significant number of patients, who are faced with the debilitating symptoms of PAH and treatment adverse effects. Palliative care is focused on providing relief from symptoms caused by a chronic illness. Palliative care aims to improve the health-related quality of life for patients and families, and although it is deemed appropriate at any stage of disease, it is most helpful when explored early in the course of disease. Importantly, palliative care can be provided in concert with pharmacological treatment. Despite its potential benefits, palliative care is frequently underutilised. There is a paucity of clinical studies testing the impact of palliative care in PAH which prompted us to summarise the available evidence, recognise obstacles in its utilisation and identify areas for future research.

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The impact and financial burden of pulmonary arterial hypertension on patients and caregivers

Abstract: Supplemental Digital Content is available in the text

Cited by 37 publications

References 17 publications

Anxiety and depression in patients with pulmonary arterial hypertension and chronic thromboembolic pulmonary hypertension: Results from a Chinese survey

Anxiety and depression in patients with pulmonary arterial hypertension and chronic thromboembolic pulmonary hypertension: Results from a Chinese survey

Tetramethylpyrazine: A promising drug for the treatment of pulmonary hypertension

Palliative care in pulmonary arterial hypertension: an underutilised treatment

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