Idiopathic pulmonary hypertension-related hospitalizations down in past decade
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A new study highlights a reduction in idiopathic pulmonary artery hypertension-related hospitalizations in the U.S. from 2007 to 2017.
Moreover, researchers reported lower all-cause mortality related to hospitalization, but increased health care costs.
The data come from an analysis of National Inpatient Sample-based hospitalization data, comparing 2007 with 2017.
“This is the first large, retrospective cohort study of patients with a diagnosis of idiopathic PAH that compared the outcomes of hospitalizations for idiopathic PAH 10 years apart,” Bisharah Rizvi, MD, with Saint Agnes Medical Center, Fresno, California, said during a virtual presentation at the CHEST Annual Meeting.
In 2007, there were 17,713 idiopathic PAH-related hospitalizations, representing 0.05% of all hospitalizations, compared with 9,330 in 2017, representing 0.03% of all hospitalizations (P < .001), according to Rizvi.
Those hospitalized were more likely to be women compared with men (65.2% in 2007 and 68.4% in 2017). White adults had a higher number of hospitalizations (67.4% in 2007 and 64.1% in 2017) compared with Black and Hispanic adults.
Medicare was the primary payer at both time points (67.4% in 2007 and 62.3% in 2017).
Most of the admissions occurred in large bed hospitals, approximately 60% in both years, Rizvi said. There was no difference in median length of hospital stay for idiopathic PAH, which was 5 days at both time points.
Total median charges, in U.S. dollars, increased from approximately $26,000 in 2007 to $46,000 in 2017 (P < .001).
Some regional variations emerged, Rizvi said. In the Northeast, hospitalizations decreased from 35.4% in 2007 to 20.9%, but hospitalizations increased in the Midwest (16.8% to 23.7%), South (31.7% to 34.1%) and West (16.1% to 21.3%). The reasons for this variation are unclear, Rizvi said.
All-cause and in-hospital mortality decreased from 6.4% in 2007 to 4.8% in 2017 (P < .001). Independent predictors of all-cause mortality in idiopathic PAH-related hospitalizations were age 45 to 64 years, or older than 65 years and male sex. Black and Hispanic patients had lower mortality compared with white patients. The researchers also evaluated outcomes of cardiac arrest in idiopathic PAH and found that fewer patients had cardiac arrest in 2007 (1% vs. 1.6%). Cardiac arrest as a predictor of all-cause mortality in idiopathic PAH was associated with an adjusted OR of 27.22 (P < .001).
Rizvi noted that men had higher mortality, although the percent of hospitalizations for women was significantly higher. There are several theories, Rizvi said, including the role of female sex hormones, better response to therapy in women and genetic mutations.
“Further epidemiological studies are needed to understand the nuances in idiopathic PAH-related hospitalizations and outcomes,” the researchers wrote in the abstract.