Abstract Rationale Patients with chronic thromboembolic pulmonary hypertension (CTEPH) usually present to medical attention in middle age. However, a substantial proportion of patients are elderly, and their treatment patterns and disease trajectories remain poorly characterized. We hypothesized that CTEPH patients ≥70 years old would have a unique clinical profile, different therapeutic strategies, and worse outcomes compared to younger patients. Methods The Pulmonary Hypertension Association Registry is a prospective cohort of pulmonary arterial hypertension and CTEPH patients new to care at a Pulmonary Hypertension Care Center in the United States. Individuals 18 years of age and those with pulmonary arterial hypertension were excluded. Clinical data, functional parameters, quality of life measures, and treatments were recorded at time of enrollment and follow-up. Elderly patients were defined as ≥ 70 years old and compared to younger patients in terms of treatment, change in six-minute walk distance (6MWD), World Health Organization functional class (WHO FC), and time to all-cause mortality using linear, binomial, and Cox regression, respectively, adjusted for potential confounders. Results The study sample included 159 elderly (mean age 76.6 years) and 444 non-elderly (mean age 52.8 years) CTEPH patients. Elderly patients differed from younger patients in a variety of demographic and baseline clinical variables (Table). Elderly patients exhibited lower right atrial pressure and slightly lower mean pulmonary artery pressure, with comparable pulmonary vascular resistance and cardiac index to younger patients. Elderly patients had higher rates of balloon pulmonary angioplasty (hazard ratio 1.91, 95%CI 1.01 - 3.62, p = 0.047) and lower rates of pulmonary thromboendarterectomy (PTE) (hazard ratio 0.37, 95%CI 0.20 - 0.70, p = 0.002) compared to younger patients after adjustment for covariates. There was no difference in the type or total number of medications utilized between groups. Over time, elderly patients exhibited less improvement in 6MWD (mean difference in change from baseline -36.4 m, 95%CI -67.8 - -5.1) compared with younger adults. Elderly patients had an increased risk of death compared to younger adults (hazard ratio 3.56, 95%CI 1.93 - 6.58, p 0.001) after adjustment for covariates. Conclusions Elderly CTEPH patients have distinct interventional management strategies early after diagnosis and worse clinical outcomes compared with younger patients. Advanced age introduces unique challenges in the management of CTEPH. Focused investigation of elderly patients could facilitate a more comprehensive understanding of patient-centered outcomes and inform the development of age-specific, high-value therapeutic strategies. This abstract is funded by: None
Reddy et al. (Fri,) studied this question.