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Zuin M, Bilato C, Rigatelli G, Quadretti L, Roncon L. Trends in age-specific and sex-specific pulmonary hypertension mortality in Italy between 2005 and 2017. J Cardiovasc Med (Hagerstown) 2023; 24:289-296. [PMID: 36938812 DOI: 10.2459/jcm.0000000000001457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2023]
Abstract
AIMS Data regarding the pulmonary hypertension (PH)-related mortality and relative trends in the Italian population remain scant. We sought to assess the PH mortality rates and relative trends among the Italian population between 2005 and 2017. METHODS Data regarding the cause-specific mortality and population size by sex in 5-year age groups were extracted from the WHO global mortality database. The age-standardized mortality rates, with relative 95% confidence intervals (CIs), also stratified by sex, were using the direct method. Joinpoint regression analyses were used to identify periods with statistically distinct log linear trends in PH-related death rates. To calculate nationwide annual trends in DCM-related mortality, we assessed the average annual percentage change (AAPC) and relative 95% CIs. RESULTS In Italy, the PH age-standardized annual mortality rate decreased from 2.34 (95% CI: 2.32-2.36) deaths per 100 000 to 1.51 (95% CI: 1.48-1.53) deaths per 100 000 population. Over the entire period, men had higher PH-related mortality rates than women. Moreover, the PH-related mortality trend rose with a seemingly exponential distribution with a similar trend among male and female individuals. Joinpoint regression analysis revealed a linear significant decrease in age-standardized PH-related mortality from 2005 to 2017 [AAPC: -3.1% (95% CI: -3.8 to -2.5), P < 0.001] in the entire Italian population. However, the decline was more pronounced among men [AAPC: -5.0 (95% CI: -6.1 to -3.9), P < 0.001] compared with women [AAPC: -1.5 (95% CI: -2.3 to -0.7), P = 0.001]. CONCLUSION In Italy, the PH-related mortality rates linearly declined from 2005 to 2017.
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Affiliation(s)
- Marco Zuin
- Department of Cardiology, West Vicenza Hospital, Arzignano, Vicenza.,Department of Translational Medicine, University of Ferrara, Ferrara
| | - Claudio Bilato
- Department of Cardiology, West Vicenza Hospital, Arzignano, Vicenza
| | | | - Laura Quadretti
- Department of Cardiology, Casa di Cura Madonna della Slaute, Porto Viro
| | - Loris Roncon
- Department of Cardiology, Santa Maria della Misericordia Hospital, Rovigo, Italy
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Pérez Peñate G, Ochoa Parra N, Domingo Morera JA, Martínez Meñaca A, López Ramón M, Cadenas Menéndez S, León Marrero F, Gómara de la Cal S, Ghadban Garrido C, Royo Tolosana P, Martin Puentes J, Aldonza Aguayo R, Mahdavi H, Bacchini Jeanneret G, Escribano Subías P. Evaluation of a digital health system (PAHcare™) for routine care of patients with pulmonary arterial hypertension: The CBS-PAH study protocol. Front Public Health 2022; 10:954487. [PMID: 36568758 PMCID: PMC9768478 DOI: 10.3389/fpubh.2022.954487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 11/14/2022] [Indexed: 12/12/2022] Open
Abstract
Introduction Pulmonary arterial hypertension (PAH) is a rare, multifactorial, chronic condition that requires ongoing monitoring and assessment. PAHcare™ is a novel, patient-centered digital platform that provides software intended for use on patients' mobile phones (downloadable application) and web-based dashboards for use by physicians and health coaches (HC). We describe herein the protocol of a clinical study aimed at evaluating the clinical benefit and safety of PAHcare™ for the routine management of patients with PAH. Methods and analysis In this prospective, single cohort, multicenter study, 50 patients with PAH will be recruited at six specialized PAH units from reference hospitals of the public Spanish healthcare system. The PAHcare™ digital health platform allows patients to log health and lifestyle information while also providing structured content for patient education, medication reminders, and behavioral and lifestyle coaching from a remote HC. Evaluation will be primarily focused on the impact of the platform use on the patient's health-related quality of life (HRQoL) via questionnaires completion through electronic patient-reported outcomes. Moreover, the analysis of the impact on the patient's functional status, signs and symptoms of PAH, patient costs and healthcare resource utilization, satisfaction, knowledge of the disease and its management, and adherence to and safety of the platform will be secondary outcomes. The clinical investigation started in July 2021 and is expected to end by September 2022. Discussion The PAHcare™ platform is anticipated to provide direct benefits to healthcare professionals, patients, and caregivers. These include the simplification of the multidisciplinary approach needed to tailor routine PAH management, enhancement of the patient/healthcare professional interaction, patient's empowerment to become more actively involved in the management and treatment of the disease, and increase of the patient's and caregiver's knowledge on PAH.
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Affiliation(s)
- Gregorio Pérez Peñate
- Unidad Multidisciplinar de Circulación Pulmonar, Servicio de Neumología, Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria, Spain
| | - Nuria Ochoa Parra
- Unidad Multidisciplinar de Hipertensión Pulmonar, Servicio de Cardiología, Hospital Universitario 12 de Octubre, Madrid, Spain,Instituto de Investigación Sanitaria Hospital 12 de Octubre (i+12), Madrid, Spain
| | | | - Amaya Martínez Meñaca
- Servicio de Neumología, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Marta López Ramón
- Servicio de Cardiología, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - Sergio Cadenas Menéndez
- Servicios de Neumología y Cardiología, Unidad de Hipertensión Pulmonar, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain
| | - Fernando León Marrero
- Unidad Multidisciplinar de Circulación Pulmonar, Servicio de Neumología, Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria, Spain
| | | | | | | | - Javier Martin Puentes
- Servicios de Neumología y Cardiología, Unidad de Hipertensión Pulmonar, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain
| | | | - Hadis Mahdavi
- Digital Health and Technology, Ferrer, Barcelona, Spain
| | | | - Pilar Escribano Subías
- Unidad Multidisciplinar de Hipertensión Pulmonar, Servicio de Cardiología, Hospital Universitario 12 de Octubre, Madrid, Spain,Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain,*Correspondence: Pilar Escribano Subías
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Beghetti M, Gorenflo M, Ivy DD, Moledina S, Bonnet D. Treatment of pediatric pulmonary arterial hypertension: A focus on the NO-sGC-cGMP pathway. Pediatr Pulmonol 2019; 54:1516-1526. [PMID: 31313530 PMCID: PMC6771736 DOI: 10.1002/ppul.24442] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 05/28/2019] [Indexed: 11/20/2022]
Abstract
OBJECTIVE While pulmonary arterial hypertension (PAH) is rare in infants and children, it results in substantial morbidity and mortality. In recent years, prognosis has improved, coinciding with the introduction of new PAH-targeted therapies, although much of their use in children is off-label. Evidence to guide the treatment of children with PAH is less extensive than for adults. The goal of this review is to discuss the treatment recommendations for children with PAH, as well as the evidence supporting the use of prostanoids, endothelin receptor antagonists (ERAs), and phosphodiesterase type 5 inhibitors (PDE5i) in this setting. DATA SOURCES Nonsystematic PubMed literature search and authors' expertise. STUDY SELECTION Articles were selected concentrating on the nitric oxide (NO)-soluble guanylate cyclase (sGC)-cyclic guanosine monophosphate (cGMP) pathway in PAH. The methodology of an ongoing study evaluating the sGC stimulator riociguat in children with PAH is also described. RESULTS Despite recent medical advances, improved therapeutic strategies for pediatric PAH are needed. The efficacy and tolerability of riociguat in adults with PAH have been well trialed. CONCLUSION The pooling of data across trials, supplemented by registry data, will help to confirm the safety and tolerability of prostanoids, ERAs, and PDE5i in children. Ongoing studies will clarify the place of sGC stimulators in the treatment strategy for pediatric PAH.
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Affiliation(s)
- Maurice Beghetti
- Pediatric Cardiology Unit and Centre Universitaire de Cardiologie et Chirurgie Cardiaque PédiatriqueChildren's University HospitalGenevaSwitzerland
| | - Matthias Gorenflo
- Department of Pediatrics II, Pediatric Cardiology and Congenital Heart Defects, Center for PediatricsUniversity Hospital HeidelbergGermany
| | - D. Dunbar Ivy
- Children's Hospital Colorado, Heart InstituteUniversity of Colorado School of MedicineDenverColorado
| | - Shahin Moledina
- Cardiology DepartmentGreat Ormond Street Hospital for Children NHS Foundation TrustLondonUK
| | - Damien Bonnet
- M3C‐Paediatric Cardiology, Necker Enfants Malades, AP‐HPUniversité Paris DescartesParisFrance
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Amin A, Mohamadifar A, Keshmiri MS, Ghadrdoost B, Taghavi S, Naderi N. A simple hemodynamic parameter to predict clinical worsening in pulmonary arterial hypertension. J Crit Care 2016; 38:324-327. [PMID: 27988069 DOI: 10.1016/j.jcrc.2016.12.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2016] [Revised: 12/01/2016] [Accepted: 12/04/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Predicting prognosis is a cornerstone in management of pulmonary arterial hypertension. Hemodynamic parameters are among the robust indicators of right ventricular function and prognosis. In this study we have investigated the association of a simple hemodynamic parameter with clinical worsening in pulmonary arterial hypertension. METHODS AND PATIENTS 120 patients were enrolled in a single center prospective cohort study after confirmation of precapillary pulmonary hypertension and were followed for an average of 36months on guideline recommended treatment protocols. cSvO2 was calculated as the ratio of right atrial pressure over Mixed Venous Oxygen Saturation. Independent predictors of clinical worsening were identified using multivariable Cox regression models. RESULTS By the end of the follow up a total of 21 patients died and 63 were hospitalized for pulmonary hypertension. Time-to-event Cox regression model showed a strong association between cSvO2 and time to clinical worsening (HR: 250.13, CI: (38.56-1622.34) &p-value: <0.0001). CONCLUSION The index of cSvO2 includes both parameters of cardiac output and right ventricular filling pressure and might be beneficial in predicting clinical worsening in patients with pulmonary arterial hypertension.
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Affiliation(s)
- Ahmad Amin
- Department of Heart Failure and Transplantation, Rajaie Cardiovascular, Medical and Research Center, Iran University of Medical Science, Tehran, Iran.
| | - Arezoo Mohamadifar
- Rajaie Cardiovascular, Medical and Research Center, Iran University of Medical Science, Tehran, Iran
| | - Mohammad Sadegh Keshmiri
- Rajaie Cardiovascular, Medical and Research Center, Iran University of Medical Science, Tehran, Iran
| | - Behshid Ghadrdoost
- Rajaie Cardiovascular, Medical and Research Center, Iran University of Medical Science, Tehran, Iran
| | - Sepideh Taghavi
- Department of Heart Failure and Transplantation, Rajaie Cardiovascular, Medical and Research Center, Iran University of Medical Science, Tehran, Iran
| | - Nasim Naderi
- Department of Heart Failure and Transplantation, Rajaie Cardiovascular, Medical and Research Center, Iran University of Medical Science, Tehran, Iran
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