Key result
Combination therapy for pulmonary arterial hypertension increased from 6.7% before 2015 to 35.5% thereafter, but approximately half of re-evaluated patients did not achieve low-risk profiles.
Why the study?
Nationally representative reports on PAH characteristics and survival from developing countries are scarce, and the real-world applicability of risk stratifications and longitudinal changes in goal-oriented treatments remained unclear.
What are the characteristics, treatment patterns, and survival outcomes of PAH patients in China, and do current risk stratifications apply?
Cohort (n=2,031)
Yes
What are the characteristics, treatment patterns, and survival outcomes of PAH patients in China, and do current risk stratifications apply?
In a large Chinese registry, PAH patients frequently have congenital heart disease aetiology, and while risk stratification tools are effective, many patients fail to achieve low-risk profiles, underscoring the need for more aggressive combination therapy.
Many Chinese PAH patients fail low-risk targets at follow-up; leaves open whether intensified goal-oriented combination therapy improves outcomes in this population.
BACKGROUND AND OBJECTIVE: Nationally representative reports on the characteristics and long-term survival of pulmonary arterial hypertension (PAH) from developing countries are scarce. The applicability of the current main risk stratifications and the longitudinal changes in goal-oriented treatments have yet to be elucidated in real-world settings. Therefore, we aimed to provide insights into the characteristics, goal-oriented treatments and survival of PAH in China and to explore the applicability of the main risk stratifications in our independent cohort. METHODS: PAH patients were consecutively enrolled from a national prospective multicentre registry. Data on baseline, follow-up re-evaluation and therapeutic changes were collected. RESULTS: A total of 2031 patients were enrolled, with congenital heart disease (CHD)-PAH (45.2%) being the most common aetiology. The mean age was 35 ± 12 years, and 76.2% were females. At baseline, approximately 20% of the patients with intermediate or high risk received combination treatment. At follow-up, approximately half of the re-evaluated patients did not achieve low-risk profiles, and even among patients who received combination therapy at baseline, 4% of them still worsened. The rate of combination therapy increased significantly from 6.7% before 2015 to 35.5% thereafter. The main risk assessment tools demonstrated good performance for predicting survival both at baseline and at follow-up. CONCLUSION: Chinese PAH patients show both similar and distinct features compared to other countries. Current main risk stratifications can significantly discriminate patients at different risk levels. There were still many patients not achieving low-risk profiles at follow-up, indicating more aggressive treatment should be implemented to optimize the goal-oriented treatment strategy.
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Quan et al. (2022) conducted a cohort in Pulmonary arterial hypertension (n=2,031). Goal-oriented treatments and risk stratification was evaluated on Survival and achievement of low-risk profiles. Combination therapy for pulmonary arterial hypertension increased from 6.7% before 2015 to 35.5% thereafter, but approximately half of re-evaluated patients did not achieve low-risk profiles.
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