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Rawlings GH, Gaskell C, Beail N, Thompson A, Armstrong I. Exploratory and confirmatory factor analysis of emPHasis-10: The health-related quality-of-life measure in pulmonary hypertension. Pulm Circ 2024; 14:e12378. [PMID: 38736895 PMCID: PMC11088805 DOI: 10.1002/pul2.12378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 04/11/2024] [Accepted: 04/23/2024] [Indexed: 05/14/2024] Open
Abstract
The emPHasis-10 is a health-related quality of life (HRQoL) unidimensional measure developed specifically for adults with pulmonary hypertension. The tool has excellent psychometric properties and is well used in research and clinical settings. Its factor structure has not been examined, which may help to identity a complimentary approach to using the measure to examine patient functioning. We performed an exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) on a data set collected from 263 adults with PH recruited from a community setting. The EFA suggested the emPHasis-10 consists of three underlying latent variables, which based on the loading of items, were termed "fatigue" (Items 3, 4, and 5), "independence" (Items 7, 8, 9, and 10), and "breathlessness" (Items 1, 2, and 6). All factors were found to have good internal consistency. "Independence" accounted for most of the variance (29%), followed by "breathlessness" (22%) and "fatigue" (19%). The CFA looked to confirm the fit of a three-factor model. A higher-order model was found to be the best fit consisting of HRQoL as a superordinate factor, for which the association between this factor and the 10 items was mediated through the three latent factors. Further analyses were performed testing the validity of the latent variables revealing all were significantly correlated with self-reported measures of depression, anxiety, health-anxiety, and dyspnea. Our analyses support the emPHasis-10 as a measure of HRQoL, while also proposing the clinical utility of examining the three emergent factors, which could be used to glean additional insight into the respondent's functioning and inform care.
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Affiliation(s)
- Gregg H. Rawlings
- Clinical and Applied Psychology UnitUniversity of SheffieldSheffieldUK
| | - Chris Gaskell
- Clinical and Applied Psychology UnitUniversity of SheffieldSheffieldUK
- Department of NeuropsychologyNorth Staffordshire Combined NHS Foundation TrustStoke‐on‐TrentUK
| | - Nigel Beail
- Clinical and Applied Psychology UnitUniversity of SheffieldSheffieldUK
| | - Andrew Thompson
- South Wales Clinical Psychology Training Programmes, Cardiff and Vale University Health BoardCardiff UniversityCardiffUK
| | - Iain Armstrong
- Sheffield Pulmonary Vascular Disease Unit, Sheffield Teaching Hospitals NHS Foundation TrustRoyal Hallamshire HospitalSheffieldUK
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Scagliola R, Brunelli C, Balbi M. Pulmonary Arterial Hypertension in the Elderly: Peculiar Features and Challenges for a Proper Phenotyping Approach. J Cardiovasc Dev Dis 2023; 10:401. [PMID: 37754830 PMCID: PMC10531962 DOI: 10.3390/jcdd10090401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 09/14/2023] [Accepted: 09/15/2023] [Indexed: 09/28/2023] Open
Abstract
(1) Introduction. Although pulmonary arterial hypertension (PAH) usually affects young people with a low cardiovascular risk profile, progressive epidemiologic changes have been providing a codified phenotype of elderly subjects with PAH and increased risk predictors for left heart disease. We therefore conducted a systematic review to describe the current knowledge and characteristics of elderly individuals with PAH and further insights concerning their prognostic outcomes and therapeutic response. (2) Methods. A search was conducted in PubMed, Embase, and Cochrane Library for publications evaluating the epidemiology, diagnostic work-up, and treatment of PAH in elderly subjects. (3) Among the 74 publications initially retrieved, 16 full-text articles were selected for the present systematic review. Compared to their younger counterparts, elderly individuals with PAH showed greater clinical deterioration, reduced exercise capacity, and worse prognostic outcomes, as well as less response to PAH-targeted therapy and higher rates of PAH drug discontinuation. (4) Conclusions. Demographic changes over time contributed to define a peculiar PAH phenotype in elderly patients, with an increased burden of cardiovascular comorbidities and distinctive features compared to young patients. Further investigations are needed in order to better clarify the nosologic criteria, and management in this subset population.
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Affiliation(s)
- Riccardo Scagliola
- Cardiology Division, Department of Emergency, Cardinal G. Massaia Hospital, 14100 Asti, Italy
- Pulmonary Hypertension Outpatient Clinic, Cardiovascular Disease Unit, San Martino Hospital, 16132 Genoa, Italy
| | - Claudio Brunelli
- Pulmonary Hypertension Outpatient Clinic, Cardiovascular Disease Unit, San Martino Hospital, 16132 Genoa, Italy
| | - Manrico Balbi
- Pulmonary Hypertension Outpatient Clinic, Cardiovascular Disease Unit, San Martino Hospital, 16132 Genoa, Italy
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3
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Stolfo D, Barbisan D, Ameri P, Lombardi CM, Monti S, Driussi M, Zovatto IC, Gentile P, Howard L, Toma M, Pagnesi M, Collini V, Bauleo C, Guglielmi G, Adamo M, D'Angelo L, Nalli C, Sciarrone P, Moschella M, Zorzi B, Vecchiato V, Milani M, Di Poi E, Airò E, Metra M, Garascia A, Sinagra G, Lo Giudice F. Performance of risk stratification scores and role of comorbidities in older vs younger patients with pulmonary arterial hypertension. J Heart Lung Transplant 2023; 42:1082-1092. [PMID: 37005100 DOI: 10.1016/j.healun.2023.02.1707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Revised: 01/27/2023] [Accepted: 02/28/2023] [Indexed: 03/07/2023] Open
Abstract
BACKGROUND Risk scores are important tools for the prognostic stratification of pulmonary arterial hypertension (PAH). Their performance and the additional impact of comorbidities across age groups is unknown. METHODS Patients with PAH enrolled from 2001 to 2021 were divided in ≥65 years old vs <65 years old patients. Study outcome was 5-year all-cause mortality. French Pulmonary Hypertension Network (FPHN), FPHN noninvasive, Comparative, Prospective Registry of Newly Initiated Therapies for Pulmonary Hypertension (COMPERA) and Registry to Evaluate Early and Long-term PAH Disease Management (REVEAL 2.0) risk scores were calculated and patients categorized at low, intermediate and high risk. Number of comorbidities was calculated. RESULTS Among 383 patients, 152 (40%) were ≥65 years old. They had more comorbidities (number of comorbidities 2, IQR 1-3, vs 1, IQR 0-2 in <65 years patients). Five-year survival was 63% in ≥65 vs 90% in <65 years. Risk scores correctly discriminated the different classes of risk in the overall cohort and in the older and younger groups. REVEAL 2.0 showed the best accuracy in the total cohort (C-index 0.74, standard error-SE- 0.03) and older (C-index 0.69, SE 0.03) patients, whereas COMPERA 2.0 performed better in younger patients (C-index 0.75, SE 0.08). Number of comorbidities was associated with higher 5-year mortality, and consistently increased the accuracy of risk scores, in younger but not in older patients. CONCLUSIONS Risk scores have similar accuracy in the prognostic stratification of older vs younger PAH patients. REVEAL 2.0 had the best performance in older patients and COMPERA 2.0 had it in younger patients. Comorbidities increased the accuracy of risk scores only in younger patients.
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Affiliation(s)
- Davide Stolfo
- Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI) and University Hospital of Trieste, Trieste, Italy; Division of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden.
| | - Davide Barbisan
- Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI) and University Hospital of Trieste, Trieste, Italy
| | - Pietro Ameri
- Cardiac, Vascular, and Thoracic Department, IRCCS Ospedale Policlinico San Martino, Genova, Italy; Department of Internal Medicine, University of Genova, Genova, Italy
| | - Carlo Mario Lombardi
- Cardiology, ASST Spedali Civili; Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Simonetta Monti
- Cardiology and Pneumology Division, Fondazione Toscana G. Monasterio, Pisa, Italy; Institute of Clinical Physiology (IFC)-CNR, Pisa, Italy
| | - Mauro Driussi
- Cardiology, Cardiothoracic Department, Azienda Sanitaria Universitaria Friuli Centrale (ASUFC), Udine, Italy
| | - Isabella Carlotta Zovatto
- Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI) and University Hospital of Trieste, Trieste, Italy
| | - Piero Gentile
- De Gasperis Cardio Center, Niguarda Hospital, Milano, Italy
| | - Luke Howard
- Imperial College London, Faculty of Medicine, National Heart & Lung Institute, London, UK; National Pulmonary Hypertension Service, Department of Cardiology, Hammersmith Hospital, Imperial College NHS Trust, London, UK
| | - Matteo Toma
- Cardiac, Vascular, and Thoracic Department, IRCCS Ospedale Policlinico San Martino, Genova, Italy; Department of Internal Medicine, University of Genova, Genova, Italy
| | - Matteo Pagnesi
- Cardiology, ASST Spedali Civili; Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Valentino Collini
- Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI) and University Hospital of Trieste, Trieste, Italy; Cardiology, Cardiothoracic Department, Azienda Sanitaria Universitaria Friuli Centrale (ASUFC), Udine, Italy
| | - Carolina Bauleo
- Cardiology and Pneumology Division, Fondazione Toscana G. Monasterio, Pisa, Italy
| | - Giulia Guglielmi
- Cardiac, Vascular, and Thoracic Department, IRCCS Ospedale Policlinico San Martino, Genova, Italy; Department of Internal Medicine, University of Genova, Genova, Italy
| | - Marianna Adamo
- Cardiology, ASST Spedali Civili; Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | | | - Chiara Nalli
- Cardiac Surgery, Cardiothoracic Department, Azienda Sanitaria Universitaria Friuli Centrale (ASUFC), Udine, Italy
| | - Paolo Sciarrone
- Cardiology and Pneumology Division, Fondazione Toscana G. Monasterio, Pisa, Italy
| | - Martina Moschella
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Barbara Zorzi
- Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI) and University Hospital of Trieste, Trieste, Italy; National Pulmonary Hypertension Service, Department of Cardiology, Hammersmith Hospital, Imperial College NHS Trust, London, UK
| | - Veronica Vecchiato
- Cardiac, Vascular, and Thoracic Department, IRCCS Ospedale Policlinico San Martino, Genova, Italy; Department of Internal Medicine, University of Genova, Genova, Italy
| | | | - Emma Di Poi
- Rheumatology Clinic, Department of Medicine, Azienda Sanitaria Universitaria Friuli Centrale (ASUFC), Udine, Italy
| | - Edoardo Airò
- Cardiology and Pneumology Division, Fondazione Toscana G. Monasterio, Pisa, Italy
| | - Marco Metra
- Cardiology, ASST Spedali Civili; Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | | | - Gianfranco Sinagra
- Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI) and University Hospital of Trieste, Trieste, Italy
| | - Francesco Lo Giudice
- National Pulmonary Hypertension Service, Department of Cardiology, Hammersmith Hospital, Imperial College NHS Trust, London, UK
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Omura J, Kitahara K, Takano M, Idehara K, Kim S. Real-world clinical practice of pulmonary arterial hypertension in Japan: Insights from a large administrative database. Pulm Circ 2023; 13:e12275. [PMID: 37649808 PMCID: PMC10462924 DOI: 10.1002/pul2.12275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 07/25/2023] [Accepted: 07/27/2023] [Indexed: 09/01/2023] Open
Abstract
Pulmonary arterial hypertension (PAH) is a fatal disease that often occurs at an early age. In recent years, aggressive treatment with multiple drugs from the early-stage diagnosis is expected to improve the prognosis. Indeed, a high rate of initial combination therapy and excellent treatment outcomes have been reported from specialized centers for PAH in Japan. However, information on PAH epidemiology, including non-PAH specialized centers in Japan, is unclear. To address the above, we conducted a retrospective observational cohort study from April 2008 to September 2020 using real-world evidence from a large-scale administrative database (Medical Data Vision) to examine baseline characteristics, comorbidities, and treatment profiles of Japanese patients with PAH. Five hundred and eighteen patients with PAH (treatment-naive PAH, age 67.2 ± 15.9) were identified through our comprehensive approach which combined PAH disease codes, medications, and diagnostic procedures. Moreover, we showed that a larger proportion of patients received monotherapy in their initial treatment (66%) compared to those receiving combination therapy (34%). During the 1-year follow-up after PAH diagnosis, 13% of patients increased their PAH medications while other patients either decreased their PAH medications (6%) or discontinued PAH treatment (27%). The 3- and 5-year event-free survival rates of all-cause death were 72% and 64%, respectively. This is the first large-scale administrative database study that provides insights into real-world PAH management in Japan. This study highlighted a different PAH clinical landscape which included a larger portion of the elderly population, higher initial monotherapy treatment, and lower survival rates than previous studies.
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Affiliation(s)
- Junichi Omura
- Medical AffairsJanssen Pharmaceutical K. K.TokyoJapan
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5
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Riociguat in Patients with CTEPH and Advanced Age and/or Comorbidities. J Clin Med 2022; 11:jcm11041084. [PMID: 35207354 PMCID: PMC8877433 DOI: 10.3390/jcm11041084] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Revised: 02/07/2022] [Accepted: 02/16/2022] [Indexed: 11/17/2022] Open
Abstract
Riociguat is licensed for the therapy of inoperable chronic thromboembolic pulmonary hypertension (CTEPH). We aimed to investigate whether age and comorbidities influence its tolerability and efficacy. Retrospectively, we analyzed data of tolerability, non-invasive, and invasive efficacy at baseline and follow up (FU) of all patients with CTEPH treated with riociguat at the Department of Internal Medicine V, University of Munich (n = 47), grouping patients according to age (<65 versus 65–79 versus ≥80 years) and risk factors for heart failure with preserved ejection fraction (HFpEF) (<2 versus ≥2 risk factors). During dose titration patients >80 years reported side effects more frequently (40%) than the other age groups (23% and 21% for patients <65 years and patients 65–79, respectively). Cessation of riociguat was rare and occurred independent of age. When looking at the total cohort of 47 patients, three patients stopped therapy and three patients had a reduced maintenance dosage, while 41/47 (87%) and all octogenarians reached the highest maintenance dosage of 7.5 mg/d. The frequency of any side effect was similar in patients in both risk factor groups, and hypotension was only observed in those with <2 risk factors. Parameters of efficacy improved significantly under riociguat treatment. Improvement in 6-min walk distance (6 mwd), N-terminal pro brain natriuretic peptide (Nt-proBNP) and hemodynamics did not differ between age or risk factor groups. In this small real-life cohort, riociguat was well-tolerated and effective in advanced age and risk factors for HFpEF.
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6
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Yokose M, Tomoe T, Yamaguchi T, Yasu T. An autopsy case of pulmonary arterial hypertension in an elderly patient with multimorbidity: a case report. Eur Heart J Case Rep 2022; 6:ytab527. [PMID: 35028503 PMCID: PMC8753136 DOI: 10.1093/ehjcr/ytab527] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 07/26/2021] [Accepted: 12/22/2021] [Indexed: 11/12/2022]
Abstract
Abstract
Background
There is an increasing number of elderly patients with pulmonary arterial hypertension (PAH), and their characteristics differ from those of young or middle-aged patients with this condition.
Case summary
A 73-year-old woman with a history of myocardial infarction and cardiovascular risk factors was admitted to the hospital with 2-week exertional dyspnoea. Her initial diagnosis was heart failure with preserved ejection fraction, but the symptoms persisted despite receiving treatment with diuretics. Additional tests showed a significant decrease in diffusing capacity of carbon monoxide and findings suggestive of severe pulmonary hypertension (PH). Contrast-enhanced computed tomography of the chest, and pulmonary angiography, showed no narrowing or obstruction of the pulmonary arteries. Right heart catheterization revealed haemodynamic data implying pre-capillary PH. Her condition gradually deteriorated to World Health Organization functional class IV, and sequential combination therapy with tadalafil, macitentan, and selexipag was initiated with a PAH diagnosis; however, she died 1 month later. Pathological findings in autopsy were consistent with PAH, and some parts of the lungs revealed the presence of obstructive and interstitial lung disease.
Discussion
The majority of elderly patients with PAH might have multimorbidity. However, there is no specific treatment strategy. It is associated with diagnostic delay and worse prognosis; therefore, early suspicion and comprehensive tests, including right heart catheterization, are essential for better management.
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Affiliation(s)
- Masashi Yokose
- Department of Cardiovascular Medicine and Nephrology, Dokkyo Medical University Nikko Medical Center, 632 Takatoku, Nikko, Tochigi 321-2593, Japan
| | - Takashi Tomoe
- Department of Cardiovascular Medicine and Nephrology, Dokkyo Medical University Nikko Medical Center, 632 Takatoku, Nikko, Tochigi 321-2593, Japan
| | - Takehiko Yamaguchi
- Department of Pathology, Dokkyo Medical University Nikko Medical Center, 632 Takatoku, Nikko, Tochigi 321-2593, Japan
| | - Takanori Yasu
- Department of Cardiovascular Medicine and Nephrology, Dokkyo Medical University Nikko Medical Center, 632 Takatoku, Nikko, Tochigi 321-2593, Japan
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Rosenkranz S, Channick R, Chin KM, Jenner B, Gaine S, Galiè N, Ghofrani HA, Hoeper MM, McLaughlin VV, Du Roure C, Rubin LJ, Sitbon O, Tapson V, Lang IM. The impact of comorbidities on selexipag treatment effect in patients with pulmonary arterial hypertension: insights from the GRIPHON study. Eur J Heart Fail 2021; 24:205-214. [PMID: 34806261 PMCID: PMC9298818 DOI: 10.1002/ejhf.2369] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 09/23/2021] [Accepted: 10/17/2021] [Indexed: 11/23/2022] Open
Abstract
Aims The number of pulmonary arterial hypertension (PAH) patients with comorbidities is increasing and there are limited data on response to PAH‐targeted therapies in this population. These post hoc analyses explored the effect of selexipag in PAH patients with cardiovascular comorbidities in the GRIPHON study. Methods and results Randomized patients (n = 1156) were classified using three methods: (i) by subgroups defined according to previously published comorbidity count and restrictive haemodynamic criteria: Subgroup A (<3 comorbidities and haemodynamic criteria met; n = 962) and Subgroup B (≥3 comorbidities and/or haemodynamic criteria not met; n = 144); comorbidities included body mass index ≥30 kg/m2, essential hypertension, diabetes, history of coronary artery disease; (ii) by number of comorbidities, with addition of atrial fibrillation (0, 1, 2, 3, 4, or 5); (iii) by presence of individual comorbidities. Selexipag to placebo hazard ratios (HR) and 95% confidence intervals (CI) for morbidity/mortality (primary composite endpoint) were estimated using Cox regression adjusting selexipag effect for baseline covariates. Approximately half of the patients in GRIPHON (n = 584; 50.5%) had comorbidities. Selexipag reduced the risk of a morbidity/mortality event compared with placebo in both Subgroup A (HR 0.66, 95% CI 0.53, 0.82) and Subgroup B (HR 0.50, 95% CI 0.26, 0.96), with no evidence of an inconsistent treatment effect between subgroups (interaction p = 0.432). Consistent results were observed in analyses by number and by specific type of comorbidity. Conclusion Selexipag reduces the risk of a morbidity/mortality event vs. placebo irrespective of patient comorbidity status, suggesting that comorbidity status does not influence the treatment effect of selexipag.
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Affiliation(s)
- Stephan Rosenkranz
- Heart Center, University Hospital Cologne, and Cologne Cardiovascular Research Center (CCRC), Cologne, Germany
| | | | | | | | - Sean Gaine
- Mater Misericordiae University Hospital, Dublin, Ireland
| | - Nazzareno Galiè
- DIMES, University of Bologna and IRCCS, S. Orsola University Hospital, Bologna, Italy
| | - Hossein-Ardeschir Ghofrani
- University of Giessen and Marburg Lung Center, Giessen, Germany, member of the German Center for Lung Research, and Department of Medicine, Imperial College London, London, UK
| | - Marius M Hoeper
- Department of Respiratory Medicine, Hannover Medical School and German Center for Lung Research, Hannover, Germany
| | | | | | - Lewis J Rubin
- Division of Pulmonary and Critical Care Medicine, University of California, San Diego, CA, USA
| | - Olivier Sitbon
- Hôpital Universitaire de Bicêtre, Université Paris-Sud, Le Kremlin Bicêtre, France
| | | | - Irene M Lang
- Division of Cardiology, Medical University of Vienna, Vienna, Austria
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8
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Stubbe B, Seyfarth HJ, Kleymann J, Halank M, Al Ghorani H, Obst A, Desole S, Ewert R, Opitz CF. Monotherapy in patients with pulmonary arterial hypertension at four German PH centres. BMC Pulm Med 2021; 21:130. [PMID: 33882879 PMCID: PMC8061059 DOI: 10.1186/s12890-021-01499-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 04/13/2021] [Indexed: 11/16/2022] Open
Abstract
Background Although combination therapy is the gold standard for patients with pulmonary arterial hypertension (PAH), some of these patients are still being treated with monotherapy. Methods We conducted a retrospective analysis at four German PH centres to describe the prevalence and characteristics of patients receiving monotherapy. Results We identified 131 incident PAH patients, with a mean age of 64 ± 13.8 years and a varying prevalence of comorbidities, cardiovascular risk factors and targeted therapy. As in other studies, the extent of prescribed PAH therapy varied with age and coexisting diseases, and younger, so-called “typical” PAH patients were more commonly treated early with combination therapy (48% at 4–8 months). In contrast, patients with multiple comorbidities or cardiovascular risk factors were more often treated with monotherapy (69% at 4–8 months). Survival at 12 months was not significantly associated with the number of PAH drugs used (single, dual, triple therapy) and was not different between “atypical” and “typical” PAH patients (89% vs. 85%). Conclusion Although “atypical” PAH patients with comorbidities or a more advanced age are less aggressively treated with respect to combination therapy, the outcome of monotherapy in these patients appears to be comparable to that of dual or triple therapy in “typical” PAH patients.
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Affiliation(s)
- Beate Stubbe
- Internal Medicine B, Pneumology, University Hospital Greifswald, Greifswald, Germany.
| | | | - Janina Kleymann
- Internal Medicine, Pneumology, University Hospital Dresden, Dresden, Germany
| | - Michael Halank
- Internal Medicine, Pneumology, University Hospital Dresden, Dresden, Germany
| | - Hussam Al Ghorani
- Internal Medicine, Cardiology, DRK Kliniken Berlin and Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Anne Obst
- Internal Medicine B, Pneumology, University Hospital Greifswald, Greifswald, Germany
| | - Susanna Desole
- Internal Medicine B, Pneumology, University Hospital Greifswald, Greifswald, Germany
| | - Ralf Ewert
- Internal Medicine B, Pneumology, University Hospital Greifswald, Greifswald, Germany
| | - Christian F Opitz
- Internal Medicine, Cardiology, DRK Kliniken Berlin and Charité-Universitätsmedizin Berlin, Berlin, Germany
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9
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Lang IM, Palazzini M. The burden of comorbidities in pulmonary arterial hypertension. Eur Heart J Suppl 2019; 21:K21-K28. [PMID: 31857797 PMCID: PMC6915052 DOI: 10.1093/eurheartj/suz205] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Indexed: 01/22/2023]
Abstract
Patients with comorbidities are often excluded from clinical trials, limiting the evidence base for pulmonary arterial hypertension (PAH)-specific therapies. This review aims to discuss the effect of comorbidities on the diagnosis and management of PAH. The comorbidities discussed in this review (systemic hypertension, obesity, sleep apnoea, clinical depression, obstructive airway disease, thyroid disease, diabetes, and ischaemic cardiovascular event) were chosen based on their prevalence in patients with idiopathic PAH in the REVEAL registry (Registry to EValuate Early and Long-term PAH disease management). Comorbidities can mask the symptoms of PAH, leading to delays in diagnosis and also difficulty evaluating disease progression and treatment effects. Due to the multifactorial pathophysiology of pulmonary hypertension (PH), the presence of comorbidities can lead to difficulties in distinguishing between Group 1 PH (PAH) and the other group classifications of PH. Many comorbidities contribute to the progression of PAH through increased pulmonary artery pressures and cardiac output, therefore treatment of the comorbidity may also reduce the severity of PAH. Similarly, the development of one comorbidity can be a risk factor for the development of other comorbidities. The management of comorbidities requires consideration of drug interactions, polypharmacy, adherence and evidence-based strategies. A multidisciplinary team should be involved in the management of patients with PAH and comorbidities, with appropriate referral to supportive services when necessary. The treatment goals and expectations of patients must be managed in the context of comorbidities.
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Affiliation(s)
- Irene M Lang
- Department of Internal Medicine II, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Massimiliano Palazzini
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Via Zamboni, 33 - 40126 Bologna, Italy
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10
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Vachiéry JL, Galiè N. Beyond the World Symposium on Pulmonary Hypertension: practical management of pulmonary arterial hypertension and evolving concepts. Eur Heart J Suppl 2019; 21:K1-K3. [PMID: 31857794 PMCID: PMC6915054 DOI: 10.1093/eurheartj/suz209] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Affiliation(s)
- Jean-Luc Vachiéry
- Department of Cardiology, Pulmonary Hypertension and Heart Failure Clinic, Cliniques Universitaires de Bruxelles—Hôpital Erasme, 808 Route de Lennik, 1070 Brussels, Belgium
| | - Nazzareno Galiè
- Department of Experimental, Diagnostic and Specialty Medicine, DIMES Alma Mater Studiorum University of Bologna, Via Zamboni, 33 - 40126 Bologna - Partita, Italy
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