Key result
Provider recognition of possible pulmonary hypertension occurred in 23.4% of cases and was associated with lower 12-month mortality compared to lack of recognition (11.3% vs 25.3%; P=0.03).
Why the study?
What are the rates and predictors of provider recognition of echocardiographic findings indicating pulmonary hypertension, and is recognition associated with improved survival?
Observational (n=227)
No
What are the rates and predictors of provider recognition of echocardiographic findings indicating pulmonary hypertension, and is recognition associated with improved survival?
Provider recognition of echocardiographic signs of pulmonary hypertension is poor (less than 1 in 4 patients), but recognition is associated with significantly lower 12-month mortality.
Low recognition of echocardiographic pulmonary hypertension was associated with higher mortality; leaves open whether detection interventions improve survival.
PH occurs alone or in association with many disorders. Many patients with transthoracic echocardiography (TTE) findings suggesting PH never receive additional evaluation. Patient characteristics and echocardiographic data associated with increased recognition of PH have not been fully evaluated. We evaluated TTE reports at the Cincinnati Veterans Affairs Medical Center from 2005 to 2006 retrospectively for findings highly indicative of PH: Estimated systolic pulmonary artery pressure (sPAP) ≥40 mmHg, increased right atrial or right ventricular (RV) size, or reduced RV function. Only patients with left ventricular ejection fraction (LVEF) ≥50% and no known diagnosis of PH were included. Patient characteristics, TTE findings, provider recognition rates, and subsequent referral for additional evaluation were assessed. A total of 227 of 3,960 (5.7%) TTE reports revealed findings indicating possible PH. Providers acknowledged possible PH in 53 (23.4%) reports. Recognized PH was predicted by increased RV size (odds ratio (OR) = 5.07, P < 0.001), increased right atrial dimension (OR = 6.45, P < 0.001), decreased RV function (OR = 8.86, P < 0.001), and increased PAP (OR = 1.04 corresponding to each unit increase of PAP, P < 0.01). Patients with comorbid obstructive sleep apnea (OSA), interstitial lung disease, and dyspnea were also more likely to be recognized (OR = 3.63, P = 0.021; OR = 10.98, P = 0.004; OR = 2.39, P = 0.007, respectively). The 12-month mortality rate for recognized patients, 11.3% (7/53), was lower than for unrecognized patients, 25.3% (44/174; P = 0.03). Providers recognized less than one in four patients with echocardiographic evidence suggesting PH. Echocardiography reports revealing higher PAP and right heart dilation and dysfunction are associated with increased acknowledgement of possible PH.
No takes yet. Share an insight, caveat, or question.
Kingrey et al. (2013) conducted an observational in Pulmonary Hypertension (n=227). Provider recognition of possible pulmonary hypertension vs. Lack of provider recognition was evaluated on 12-month mortality (p=0.03). Provider recognition of possible pulmonary hypertension occurred in 23.4% of cases and was associated with lower 12-month mortality compared to lack of recognition (11.3% vs 25.3%; P=0.03).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: