Key result
Simplified 4-criteria risk assessment successfully discriminates PAH patients into distinct survival risk groups.
Why the study?
Most PAH patients are in intermediate-risk or high-risk categories, but previous risk stratification analyses often focused on low-risk patients, necessitating a pragmatic approach to individual risk assessment.
Does a simplified risk assessment method using six parameters accurately discriminate survival risk in patients with pulmonary arterial hypertension?
Observational (n=725)
No
Does a simplified risk assessment method using six parameters accurately discriminate survival risk in patients with pulmonary arterial hypertension?
p-value: p=<0.001
A simplified risk assessment using six parameters effectively discriminates survival risk in patients with PAH, supporting the strategy of targeting a low-risk profile.
May support simplified PAH risk stratification; extends observational validation of four-criteria models but remains hypothesis-generating.
OBJECTIVE: To optimise treatment of patients with pulmonary arterial hypertension (PAH), the 2015 European Society of Cardiology/European Respiratory Society guidelines recommend using risk stratification, with the aim of patients achieving low-risk status. Previous analyses of registries made progress in using risk stratification approaches, however, the focus is often on patients with a low-risk prognosis, whereas most PAH patients are in intermediate-risk or high-risk categories. Using only six parameters with high prognostic relevance, we aimed to demonstrate a pragmatic approach to individual patient risk assessment to discriminate between patients at low risk, intermediate risk and high risk of death. METHODS: Risk assessment was performed combining six parameters in four criteria: (1) WHO functional class, (2) 6 min walk distance, (3) N-terminal pro-brain natriuretic peptide (BNP)/BNP plasma levels or right atrial pressure and (4) cardiac index or mixed venous oxygen saturation. Assessments were made at baseline and at first follow-up after 3-4 months. RESULTS: 725 PAH treatment-naive patients were analysed. Survival estimates between risk groups were statistically significant at baseline and first follow-up (p<0.001), even when the analysis was performed within PAH etiological subgroups. Similar results were observed in 208 previously treated PAH patients. Furthermore, patients who remained at or improved to low risk had a significantly better estimated survival compared with patients who remained at or worsened to intermediate risk or high risk (p≤0.005). CONCLUSION: The simplified risk-assessment method can discriminate idiopathic, connective-tissue-disease-associated and congenital-heart-disease-associated PAH patients into meaningful high-risk, intermediate-risk and low-risk groups at baseline and first follow-up. This pragmatic approach reinforces targeting a low-risk profile for PAH patients.
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Dardi et al. (2021) conducted an observational in Pulmonary arterial hypertension (PAH) (n=725). Simplified 4-criteria risk assessment strategy vs. Comparison between low, intermediate, and high-risk groups was evaluated on Survival estimates between risk groups at baseline and first follow-up (p=<0.001). A simplified risk-assessment method using four criteria successfully discriminated PAH patients into low, intermediate, and high-risk groups with significantly different survival estimates (p<0.001).
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