Kim NH, Fisher M, Poch D, Zhao C, Shah M, Bartolome S. Long-term outcomes in pulmonary arterial hypertension by functional class: a meta-analysis of randomized controlled trials and observational registries.
Pulm Circ 2020;
10:2045894020935291. [PMID:
33282180 PMCID:
PMC7691927 DOI:
10.1177/2045894020935291]
[Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 05/28/2020] [Indexed: 11/15/2022] Open
Abstract
Limited data about the long-term prognosis and response to therapy in pulmonary
arterial hypertension patients with World Health Organization functional class
I/II symptoms are available. PubMed and Embase were searched for publications of
observational registries and randomized, controlled trials in pulmonary arterial
hypertension patients published between January 2001 and January 2018. Eligible
registries enrolled pulmonary arterial hypertension patients ≥18 years,
N > 30, and reported survival by functional class.
Randomized, controlled trial inclusion criteria were pulmonary arterial
hypertension patients ≥18 years, ≥6 months of treatment, and morbidity,
mortality, or time to worsening as end points reported by functional class. The
primary outcomes were survival for registries and clinical event rates for
randomized, controlled trials. Separate random effects models were calculated
for registries and randomized, controlled trials. Four randomized, controlled
trials (n = 2482) and 10 registries (n = 6580)
were included. Registries enrolled 9%–47% functional class I/II patients (the
vast majority being functional class II) with various pulmonary arterial
hypertension etiologies. Survival rates for functional class I/II patients at
one, two, and three years were 93% (95% confidence interval (CI): 91%–95%), 86%
(95% CI: 82%–89%), and 78% (95% CI: 73%–83%), respectively. The hazard ratio for
the treatment effect in randomized, controlled trials overall was 0.61 (95% CI:
0.51–0.74) and 0.60 (95% CI: 0.44–0.82) for functional class I/II patients and
0.62 (95% CI: 0.49–0.78) for functional class III/IV. The calculated risk of
death of 22% within three years for functional class I/II patients underlines
the need for careful assessment and optimal treatment of patients with
functional class I/II disease. The randomized, controlled trial analysis
demonstrates that current medical therapies have a beneficial treatment effect
in this population.
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