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Longitudinal changes in risk status in pulmonary arterial hypertension

Bouzina, Habib LU ; Rådegran, Göran LU ; Butler, Oisin ; Hesselstrand, Roger LU ; Hjalmarsson, Clara ; Holl, Katsiaryna ; Jansson, Kjell ; Klok, Rogier ; Söderberg, Stefan and Kjellström, Barbro LU (2020) In ESC Heart Failure
Abstract

Aims: Low-risk status in pulmonary arterial hypertension (PAH) predicts better survival. The present study aimed to describe changes in risk status and treatment approaches over multiple clinical assessments in PAH, taking age and comorbidity burden into consideration. Methods and results: The study included incident patients from the Swedish PAH registry, diagnosed with PAH in 2008–2019. Group A (n = 340) were ≤75 years old with <3 comorbidities. Group B (n = 163) were >75 years old with ≥3 comorbidities. Assessments occurred at baseline, first-year (Y1) and third-year (Y3) follow-ups. The study used an explorative and descriptive approach. Group A: median age was 65 years, 70% were female, and 46% had no comorbidities at... (More)

Aims: Low-risk status in pulmonary arterial hypertension (PAH) predicts better survival. The present study aimed to describe changes in risk status and treatment approaches over multiple clinical assessments in PAH, taking age and comorbidity burden into consideration. Methods and results: The study included incident patients from the Swedish PAH registry, diagnosed with PAH in 2008–2019. Group A (n = 340) were ≤75 years old with <3 comorbidities. Group B (n = 163) were >75 years old with ≥3 comorbidities. Assessments occurred at baseline, first-year (Y1) and third-year (Y3) follow-ups. The study used an explorative and descriptive approach. Group A: median age was 65 years, 70% were female, and 46% had no comorbidities at baseline. Baseline risk assessment yielded low (23%), intermediate (66%), and high risk (11%). Among patients at low, intermediate, or high risk at baseline, 51%, 18%, and 13%, respectively, were at low risk at Y3. At baseline, monotherapy was the most common therapy among low (68%) and intermediate groups (60%), while dual therapy was the most common among high risk (69%). In patients assessed as low, intermediate, or high risk at Y1, 66%, 12%, and 0% were at low risk at Y3, respectively. Of patients at intermediate or high risk at Y1, 35% received monotherapy and 13% received triple therapy. In low-risk patients at Y1, monotherapy (40%) and dual therapy (43%) were evenly distributed. Group B: median age was 77 years, 50% were female, and 44% had ≥3 comorbidities at baseline. At baseline, 8% were at low, 80% at intermediate, and 12% at high risk. Monotherapy was the most common therapy (62%) in Group B at baseline. Few patients maintained or reached low risk at follow-ups. Conclusions: Most patients with PAH did not meet low-risk criteria during the 3 year follow-up. The first year from diagnosis seems important in defining the longitudinal risk status.

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; ; ; ; ; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
epub
subject
keywords
Longitudinal analysis, Pulmonary arterial hypertension, Risk Assessment, Treatment
in
ESC Heart Failure
publisher
John Wiley and Sons
external identifiers
  • scopus:85097413178
  • pmid:33305545
ISSN
2055-5822
DOI
10.1002/ehf2.13162
language
English
LU publication?
yes
id
1a6358bc-1789-4831-9ff1-5c0155113529
date added to LUP
2020-12-22 13:01:34
date last changed
2021-02-23 02:22:12
@article{1a6358bc-1789-4831-9ff1-5c0155113529,
  abstract     = {<p>Aims: Low-risk status in pulmonary arterial hypertension (PAH) predicts better survival. The present study aimed to describe changes in risk status and treatment approaches over multiple clinical assessments in PAH, taking age and comorbidity burden into consideration. Methods and results: The study included incident patients from the Swedish PAH registry, diagnosed with PAH in 2008–2019. Group A (n = 340) were ≤75 years old with &lt;3 comorbidities. Group B (n = 163) were &gt;75 years old with ≥3 comorbidities. Assessments occurred at baseline, first-year (Y1) and third-year (Y3) follow-ups. The study used an explorative and descriptive approach. Group A: median age was 65 years, 70% were female, and 46% had no comorbidities at baseline. Baseline risk assessment yielded low (23%), intermediate (66%), and high risk (11%). Among patients at low, intermediate, or high risk at baseline, 51%, 18%, and 13%, respectively, were at low risk at Y3. At baseline, monotherapy was the most common therapy among low (68%) and intermediate groups (60%), while dual therapy was the most common among high risk (69%). In patients assessed as low, intermediate, or high risk at Y1, 66%, 12%, and 0% were at low risk at Y3, respectively. Of patients at intermediate or high risk at Y1, 35% received monotherapy and 13% received triple therapy. In low-risk patients at Y1, monotherapy (40%) and dual therapy (43%) were evenly distributed. Group B: median age was 77 years, 50% were female, and 44% had ≥3 comorbidities at baseline. At baseline, 8% were at low, 80% at intermediate, and 12% at high risk. Monotherapy was the most common therapy (62%) in Group B at baseline. Few patients maintained or reached low risk at follow-ups. Conclusions: Most patients with PAH did not meet low-risk criteria during the 3 year follow-up. The first year from diagnosis seems important in defining the longitudinal risk status.</p>},
  author       = {Bouzina, Habib and Rådegran, Göran and Butler, Oisin and Hesselstrand, Roger and Hjalmarsson, Clara and Holl, Katsiaryna and Jansson, Kjell and Klok, Rogier and Söderberg, Stefan and Kjellström, Barbro},
  issn         = {2055-5822},
  language     = {eng},
  month        = {12},
  publisher    = {John Wiley and Sons},
  series       = {ESC Heart Failure},
  title        = {Longitudinal changes in risk status in pulmonary arterial hypertension},
  url          = {http://dx.doi.org/10.1002/ehf2.13162},
  doi          = {10.1002/ehf2.13162},
  year         = {2020},
}