Pulmonary hypertension tied to adverse acute ischemic stroke in-hospital outcomes
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Pulmonary hypertension was associated with longer hospitalization and lower odds of routine discharge among patients with acute ischemic stroke, researchers reported.
In addition, among patients with pulmonary hypertension and acute ischemic stroke, men had higher rates of in-hospital mortality compared with women.
“There are no studies evaluating the impact of pulmonary hypertension on acute ischemic stroke outcomes,” Tiberiu A. Pana, MRes, first-year medical student from the Keele Cardiovascular Research Group at the Centre for Prognosis Research at the Institute for Primary Care and Health Sciences at Keele University and the Institute of Applied Health Sciences at the School of Medicine Medical Sciences & Nutrition, U.K., and colleagues wrote in the Journal of the American Heart Association. “This relationship is important, given that patients with pulmonary hypertension not only have a higher stroke incidence than the general population but may also be more vulnerable to acute stroke complications.”
The study included 221,249 patients representative of 1,106,045 admissions (median age, 72 years; 50% women) from records of acute ischemic stroke admissions from the U.S. National Inpatient Sample from October 2015 to December 2017. Researchers evaluated the relationship between pulmonary hypertension and mortality, length of hospitalization and routine home discharge.
In the cohort, 2.88% had pulmonary hypertension; the median hospital length of stay for those patients was 3 days. Patients with pulmonary hypertension were significantly older compared with patients without (80 years vs. 71 years), and there was a higher proportion of women (65% vs. 50%).
Coexisting atrial fibrillation was also present in a higher proportion of patients with pulmonary hypertension compared with those without (56.83% vs. 24.58%). Those with pulmonary hypertension were more likely to receive revascularization therapies such as IV thrombolysis (11.26% vs. 9.31%) and endovascular thrombectomy (5.17% vs. 3.05%) compared with those without it.
Researchers observed a higher proportion of in-hospital mortality (3.86% vs. 6.52%), a higher rate of hospitalization of more than 4 days (48.71% vs. 33.99%) and significantly lower proportions of routine home discharges (37.54% vs. 21.83%) among patients with pulmonary hypertension.
Although pulmonary hypertension was not associated with in-hospital mortality (OR = 0.96; 95% CI, 0.86-1.09), it was associated with higher odds for longer hospitalization (OR = 1.15; 95% CI, 1.09-1.22) and lower odds for routine discharge (OR = 0.87; 95% CI, 0.81-0.94) for both men and women.
Pulmonary hypertension was associated with a 15% greater odds of in-hospital mortality among men (OR = 1.15; 95% CI, 0.95-1.38) but not among women (OR = 0.88; 95% CI, 0.75-1.02). This highlighted a significant sex interaction for in-hospital mortality among patients with acute ischemic stroke and pulmonary hypertension (OR for women vs. men = 0.76; 95% CI, 0.6-0.97; P = .024).
Pulmonary hypertension demonstrated no significant associations with age.
“Further studies assessing post-discharge outcomes in the medium and long term after acute ischemic stroke are required to fully characterize the relationship between pulmonary hypertension and acute ischemic stroke,” the researchers wrote.
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