Key result
Severe forms of pulmonary arterial hypertension (heritable and connective tissue disease-associated) significantly increased the risk of in-hospital mortality (OR 4.5) in patients with acute right heart failure.
Why the study?
The study aimed to analyse survival, risk factors, and treatment effectiveness in patients with pulmonary arterial hypertension and chronic thromboembolic pulmonary hypertension hospitalized due to acute right heart failure.
What are the predictors of survival and mortality rates in patients with PAH and CTEPH hospitalized for acute right heart failure?
Cohort (n=70)
Yes
What are the predictors of survival and mortality rates in patients with PAH and CTEPH hospitalized for acute right heart failure?
Odds Ratio: 4.5 (95% CI 1.6–12.7)
p-value: p=0.005
Mortality in patients with pulmonary hypertension and acute right heart failure remains very high, with a two-year survival of only 41.9%, emphasizing the need for risk-adapted therapy.
May warrant closer monitoring in severe PAH during acute right heart failure; leaves open optimal strategies pending prospective validation.
OBJECTIVES: The aim of this study was to analyse survival of patients with pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH) hospitalized due to an acute right heart failure (ARHF) with emphasis on risk factors and effectiveness of treatment following current guidelines. METHODS: We retrospectively analysed 117 hospitalizations of 70 patients (59 PAH patients; 11 CTEPH patients, mean age 53.1 ± 16.77 years, 54 % females) between 2004 and 2013. RESULTS: 96 cases were hospitalized at cardiology wards (CW) while 21 at intensive care unit (ICU). The overall hospital mortality was 12.8 %, CW mortality was 4 %, and ICU mortality was 52.4 %. Higher risk of in-hospital mortality was associated with younger age, lower sodium levels, severe forms of PAH (heritable PAH, CTD-PAH) and need of PAH combination treatment. The one-year survival from the first ARHF hospitalization was 67.6 % (95 % CI 57.1-80 %), the two-year survival was 41.9 % (95 % CI 30.8-56.9 %). The presence of ascites was a predictor of long-term mortality. CONCLUSIONS: Mortality in patients with PH and ARHF remains very high. Identification of its risk factors could be used as basis of risk-adapted therapy (Tab. 5, Fig. 2, Ref. 14).
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Ambrož et al. (2020) conducted a cohort in Pulmonary arterial hypertension and chronic thromboembolic pulmonary hypertension with acute right heart failure (n=70). Severe forms of PAH (heritable PAH, CTD-PAH) vs. Other forms of PAH/CTEPH was evaluated on In-hospital mortality (OR 4.5, 95% CI 1.6-12.7, p=0.005). Severe forms of pulmonary arterial hypertension (heritable and connective tissue disease-associated) significantly increased the risk of in-hospital mortality (OR 4.5) in patients with acute right heart failure.
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