Key result
In a US veteran population with echocardiographic evidence of moderate-to-severe pulmonary hypertension, only 17.3% had a documented diagnosis, and mortality was 44.1% over a mean of 832 days.
Observational (n=340)
Yes
Moderate to severe pulmonary hypertension is significantly underdiagnosed in the US Veteran population and is associated with high mortality.
Underdiagnosis of moderate-to-severe PH in veterans associates with high mortality; leaves open whether systematic screening improves outcomes.
BACKGROUND: Pulmonary hypertension (PH) is a key contributor to cardiovascular morbidity and early mortality; however, reports are lacking on the epidemiology of PH in at-risk patient populations. METHODS AND RESULTS: The echocardiography registries from 2 major Veterans Affairs hospitals were accessed to identify patients with at least moderate PH, defined here as a pulmonary artery systolic pressure ≥60 mm Hg detected echocardiographically. From a total of 10 471 individual patient transthoracic echocardiograms, we identified moderate or severe PH in 340 patients (332 men; mean, 77 years; mean pulmonary artery systolic pressure, 69.4±10.5 mm Hg), of which PH was listed as a diagnosis in the medical record for only 59 (17.3%). At a mean of 832 days (0-4817 days) following echocardiography diagnosing PH, 150 (44.1%) patients were deceased. PH was present without substantial left heart remodeling: the mean left ventricular ejection fraction was 0.50±0.16, left ventricular end-diastolic dimension was 5.0±0.9 cm, and left atrial dimension was 4.4±0.7 cm. Cardiac catheterization (n=122, 36%) demonstrated a mean pulmonary artery pressure of 40.5±11.4 mm Hg, pulmonary capillary wedge pressure of 22.6±8.9 mm Hg, and pulmonary vascular resistance of 4.6±2.9 Wood units. Diagnostic strategies for PH were variable and often incomplete; for example, only 16% of appropriate patients were assessed with a nuclear ventilation/perfusion scan for thromboembolic causes of PH. CONCLUSIONS: in an at-risk patient population, PH is underdiagnosed and associated with substantial mortality. Enhanced awareness is necessary among practitioners regarding contemporary PH diagnostic strategies.
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Maron et al. (2013) conducted an observational in Pulmonary hypertension (n=340). In a US veteran population with echocardiographic evidence of moderate-to-severe pulmonary hypertension, only 17.3% had a documented diagnosis, and mortality was 44.1% over a mean of 832 days.
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