Pulmonary hypertension increased mortality risk by 40% in early years but this risk dropped to 15% after 2016 with increased use of guideline-directed therapies.
Does the presence of pulmonary hypertension increase mortality risk in heart failure patients, and has this prognostic impact evolved over time?
The mortality risk associated with pulmonary hypertension in heart failure patients has significantly attenuated in recent years, likely reflecting the increased adoption of guideline-directed medical therapies such as SGLT2 inhibitors, MRAs, and ARNIs.
Absolute Event Rate: 0% vs 0%
Abstract Introduction Pulmonary hypertension (PH) is a key prognostic marker in heart failure (HF), yet its management remains challenging, particularly in elderly populations. This study evaluates trends in mortality among HF patients and examines how the prognostic impact of PH has evolved over more than a decade. Purpose To analyze the evolving impact of PH on mortality in HF patients over different time periods and evaluate changes in treatment strategies. Methods A retrospective cohort study was conducted on HF patients treated from 2009 to August 2024 at a single tertiary center, including both ambulatory and hospitalized patients. Kaplan-Meier survival analysis and Cox proportional hazards models were applied. Patients were stratified by PH (defined as estimated systolic pulmonary artery pressure ≥40 mmHg) and time period (before and after June 2016). Ethical approval was obtained from the Institutional Review Board. Results The cohort included 32,902 patients (median age 72 years IQR 64–82), 19,168 (58%) males, of whom 14,627 (44%) had PH (median SPAP 44 mmHg IQR 33–52). Over a median follow-up of 5 years (IQR 1–7), 18,558 (56%) patients died. Treatment strategies evolved significantly, with increased adoption of sodium-glucose cotransporter inhibitors-2 (12% vs. 1.4%), mineralocorticoid receptor antagonists (26% vs. 6%), and angiotensin receptor/neprilysin inhibitors (11.5% vs. 3.5%). Compared with no PH, PH patients had a 40% higher mortality risk (HR 1.40, 95% CI 1.29–1.52, p 0.001). Median SPAP did not change significantly between early and late time periods (44 ±14.5 and 43.5 ± 14.5). However, interaction analysis showed PH-associated mortality risk was period-dependent, and decreased significantly from 40% in the early time period to only 15% in the late time period (95% CI 1.28–1.52 vs. 1.02–1.31, p for interaction = 0.015). Conclusions PH remains a significant predictor of mortality in contemporary HF patients. However, its impact has attenuated in recent years, potentially reflecting the adoption of guideline-directed medical therapy. These findings emphasize the need for continued innovation in HF management to improve outcomes for patients with PH.Kaplan Meier SPAP Before Median Kaplan Meier SPAP After Median
Copeland et al. (Sat,) reported a other. Pulmonary hypertension increased mortality risk by 40% in early years but this risk dropped to 15% after 2016 with increased use of guideline-directed therapies.