Newly diagnosed pulmonary arterial hypertension (PAH) patients suffer a “substantial” decline in health from the disease and register more than half of associated hospitalizations during the first three years of diagnosis, according to a study conducted by the Mayo Clinic in Jacksonville, Florida and recently published at the journal Chest.
“Mean total hospital days in the year after first admission, inclusive of first admission was 15.3 days (median 7.0 days), which represents a significant burden for both the healthcare system as a whole and for individual patients,” explained Charles Burger of the Mayo Clinic.
The research included 862 patients enrolled in the Registry to EValuate Early And Long-term PAH Disease Management (REVEAL) and had newly diagnosed PAH as defined by World Health Organization standards. 490 of the total had experienced at least one hospitalization during the 3-year follow-up period. 52.4% of the hospital admissions were PAH-related, while 43.7% were unrelated to the disease and 3.9% were due to undetermined causes.
Most of the first-time PAH-related hospitalizations were caused by congestive heart failure and placement or removal of a central venous catheter, accounting for 31.5% and 24.5% of the cases, respectively. Other causes for hospitalization included initial intravenous line insertion (11.7%), escalation of PAH therapy (8.9%), and catheter infection (8.2%), which were the most common causes for the first hospitalization brought on by the disease.
PAH-unrelated admissions, on the other hand, include infections in 21.1% of the cases, pneumonia (15.9%), surgery or other procedures (11.2%), and hemorrhage (8.9%). Regarding mortality, the rate of in-hospital cases was higher for PAH-related hospitalizations (5.4%) than unrelated ones (1.4%). The 3-year survival rate among discharged patients registered the opposite tendency, with 56.8% in the first group, compared to 67.8% in the second one.
“Our findings clearly demonstrate that all-cause hospitalization is very common among newly diagnosed patients,” Burger said. “In particular, the rate of PAH-unrelated hospitalizations in this REVEAL cohort is relatively high, suggesting that the term ‘PAH-unrelated’ is a misnomer and that this category of hospitalization actually reflects a degree of risk conferred by the PAH comorbidity.”
According to the study, patients hospitalized, regardless the reason, demonstrated a higher prevalence of comorbidity and more severe PAH, measured by the functional class, pericardial effusion, mean right atrial pressure, cardiac index, and REVEAL risk score than patients who hadn’t been admitted for hospitalizations. The numbers led to the conclusion that there are fewer differences between patients that were hospitalized with PAH-related and PAH-unrelated causes. However, the first group had more severe disease by the time of first admission.
“The lack of differences between the PAH-related and PAH-unrelated groups at enrollment is an important point, given our finding that both in-hospital and post-discharge survival are significantly worse for patients hospitalized for PAH-related reasons, despite the similar frequencies at which PAH-related and PAH-unrelated hospitalizations occur,” explained Burger.