PAH outcomes improved in specialty care centers

Patients with pulmonary arterial hypertension treated in a specialty care center had improved mortality and hospitalization, according to new data published in CHEST.

“We found that the specialty care center demonstrated improved outcomes in mortality and hospitalizations by nearly twofold, with early specialty care center referral also associated with improved outcomes,” Stephen Y. Chan, MD, PhD, FAHA, professor of medicine in the division of cardiology, director of the Vascular Medicine Institute and director of the Center for Pulmonary Vascular Biology and Medicine at the University of Pittsburgh School of Medicine and UPMC, told Healio. “We also found that the specialty care center benefit was multifactorial, potentially driven by more frequent use of specialized medications designed for PAH and more frequent disease monitoring.”

The retrospective study included 580 patients with PAH who were treated at the University of Pittsburgh Medical Center, which oversees 40 hospitals, from 2008 to 2018. Patients were categorized based on treatment in the specialty care center (n = 455; median age, 58.8 years; 68.4% female) or in a non-specialty care center (n = 125; median age, 64.8 years; 51.2% female).

Patients with PAH treated in the specialty care center presented with more comorbidities, with hypertension in 49.5% compared with 39.2% of those not treated in the specialty care center, obesity in 52.5% vs. 39.2% and sleep apnea in 17.8% vs. 8%. The researchers reported no differences in race or income between the two groups.

Stephen Chan

Patients treated in the specialty care center demonstrated improved PAH survival (HR = 0.68; 95% CI, 0.5-0.92; P = .012) and fewer hospitalizations (incidence ratio = 0.54; 95% CI, 0.42-0.69; P < .001) compared with those in the non-specialty care center group. Earlier patient referral to the specialty care center — within 6 months of diagnosis — was associated with improved PAH outcomes, according to the results.

Patients treated in the specialty care center also received more frequent disease monitoring, according to the researchers. This group was more frequently prescribed vasodilators (80.5% vs. 51.7%; P < .001) and carried more diagnostic PAH coding (75.2% vs. 30.4%; P < .001) compared with patients who were not treated in the specialty care center, according to the results. Improved PAH outcomes were associated with vasodilator treatment, with no significant difference in location (P > .05).

According to the researchers, this study highlights important differences in care provided at specialty care centers and offers evidence of the associated improvements of PAH mortality and hospitalization.

“These data offer support for establishing a network of providers for PAH patients that emphasizes specialty care services offered by the specialty care centers and integrates such practices with local providers,” Chan said. “Future studies should be structured to assess methods for optimizing an interdigitated care system, particularly to prioritize early referral and frequent disease monitoring across other control groups.”

For more information:

Stephen Y. Chan, MD, PhD, FAHA, can be reached at chansy@pitt.edu.