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Characterization of first-time hospitalizations in patients with newly diagnosed pulmonary arterial hypertension in the REVEAL registry.

Burger CD, Long PK, Shah MR, McGoon MD, Miller DP, Romero AJ, Benton WW, Safford RE - Chest (2014)

Bottom Line: Using the Registry to Evaluate Early and Long-term PAH Disease Management (REVEAL Registry), we sought to characterize first-time hospitalizations and their effect on subsequent hospitalization and survival in patients with newly diagnosed disease.Patient demographics and disease characteristics are described as well as freedom from hospitalization and survival.In the REVEAL Registry, PAH-related hospitalization was associated with relatively more rehospitalizations and worse survival at 3 years.

View Article: PubMed Central - PubMed

ABSTRACT

Background: Hospitalization is an important outcome in pulmonary arterial hypertension (PAH), shown previously to correlate with survival. Using the Registry to Evaluate Early and Long-term PAH Disease Management (REVEAL Registry), we sought to characterize first-time hospitalizations and their effect on subsequent hospitalization and survival in patients with newly diagnosed disease.

Methods: Patients with newly diagnosed PAH (n = 862, World Health Organization group 1) were evaluated for first-time hospitalization. The hospitalizations were categorized as PAH related or PAH unrelated based on the case report form. Categories for PAH-related and PAH-unrelated hospitalization were defined before independent review. Patient demographics and disease characteristics are described as well as freedom from hospitalization and survival.

Results: Of 862 patients, 490 (56.8%) had one or more hospitalizations postenrollment: 257 (52.4%) PAH related, 214 (43.7%) PAH unrelated, and 19 (3.9%) of undetermined causes. The most common causes of PAH-related hospitalization were congestive heart failure and placement/removal of a central venous catheter. Patients with PAH-related hospitalizations were more likely to receive parenteral therapy, be in functional class III/IV, and have higher risk scores before hospitalization at enrollment. Following discharge, 25.4% ± 3.2% and 31.0% ± 4.0% of patients with PAH-related and PAH-unrelated first hospitalization, respectively, remained hospitalization-free for 3 years (P = .11). Survival estimates at 3 years postdischarge were 56.8% ± 3.5% and 67.8% ± 3.6% (P = .037) for patients with PAH-related and PAH-unrelated hospitalization, respectively.

Conclusions: In the REVEAL Registry, PAH-related hospitalization was associated with relatively more rehospitalizations and worse survival at 3 years.

Trial registry: ClinicalTrials.gov; No.: NCT00370214; URL: www.clinicaltrials.gov.

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A, B, Kaplan-Meier estimates of survival for (A) patients with a first-time hospitalization from time of discharge, by type of hospitalization; and (B) patients with no hospitalization in the first year of follow-up (including patients with no hospitalizations and patients with first-time hospitalizations occurring after the first year of follow-up) from 1 y after enrollment. See Figure 1 legend for expansion of abbreviation.
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fig03: A, B, Kaplan-Meier estimates of survival for (A) patients with a first-time hospitalization from time of discharge, by type of hospitalization; and (B) patients with no hospitalization in the first year of follow-up (including patients with no hospitalizations and patients with first-time hospitalizations occurring after the first year of follow-up) from 1 y after enrollment. See Figure 1 legend for expansion of abbreviation.

Mentions: In-hospital mortality was significantly higher for PAH-related hospitalizations compared with PAH-unrelated hospitalizations (5.4% vs 1.4%, P = .024) (Table 3). Among those discharged alive following first-time hospitalization, the survival estimate at 3 years postdischarge was lower for patients with PAH-related hospitalization than for patients with PAH-unrelated hospitalization (56.8% ± 3.5% vs 67.8% ± 3.6%, P = .037) (Fig 3A). Among patients who remained hospitalization-free for 1 year postenrollment, survival after 3 additional years of follow-up was 77.8% ± 1.9% (Fig 3B).


Characterization of first-time hospitalizations in patients with newly diagnosed pulmonary arterial hypertension in the REVEAL registry.

Burger CD, Long PK, Shah MR, McGoon MD, Miller DP, Romero AJ, Benton WW, Safford RE - Chest (2014)

A, B, Kaplan-Meier estimates of survival for (A) patients with a first-time hospitalization from time of discharge, by type of hospitalization; and (B) patients with no hospitalization in the first year of follow-up (including patients with no hospitalizations and patients with first-time hospitalizations occurring after the first year of follow-up) from 1 y after enrollment. See Figure 1 legend for expansion of abbreviation.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4219341&req=5

fig03: A, B, Kaplan-Meier estimates of survival for (A) patients with a first-time hospitalization from time of discharge, by type of hospitalization; and (B) patients with no hospitalization in the first year of follow-up (including patients with no hospitalizations and patients with first-time hospitalizations occurring after the first year of follow-up) from 1 y after enrollment. See Figure 1 legend for expansion of abbreviation.
Mentions: In-hospital mortality was significantly higher for PAH-related hospitalizations compared with PAH-unrelated hospitalizations (5.4% vs 1.4%, P = .024) (Table 3). Among those discharged alive following first-time hospitalization, the survival estimate at 3 years postdischarge was lower for patients with PAH-related hospitalization than for patients with PAH-unrelated hospitalization (56.8% ± 3.5% vs 67.8% ± 3.6%, P = .037) (Fig 3A). Among patients who remained hospitalization-free for 1 year postenrollment, survival after 3 additional years of follow-up was 77.8% ± 1.9% (Fig 3B).

Bottom Line: Using the Registry to Evaluate Early and Long-term PAH Disease Management (REVEAL Registry), we sought to characterize first-time hospitalizations and their effect on subsequent hospitalization and survival in patients with newly diagnosed disease.Patient demographics and disease characteristics are described as well as freedom from hospitalization and survival.In the REVEAL Registry, PAH-related hospitalization was associated with relatively more rehospitalizations and worse survival at 3 years.

View Article: PubMed Central - PubMed

ABSTRACT

Background: Hospitalization is an important outcome in pulmonary arterial hypertension (PAH), shown previously to correlate with survival. Using the Registry to Evaluate Early and Long-term PAH Disease Management (REVEAL Registry), we sought to characterize first-time hospitalizations and their effect on subsequent hospitalization and survival in patients with newly diagnosed disease.

Methods: Patients with newly diagnosed PAH (n = 862, World Health Organization group 1) were evaluated for first-time hospitalization. The hospitalizations were categorized as PAH related or PAH unrelated based on the case report form. Categories for PAH-related and PAH-unrelated hospitalization were defined before independent review. Patient demographics and disease characteristics are described as well as freedom from hospitalization and survival.

Results: Of 862 patients, 490 (56.8%) had one or more hospitalizations postenrollment: 257 (52.4%) PAH related, 214 (43.7%) PAH unrelated, and 19 (3.9%) of undetermined causes. The most common causes of PAH-related hospitalization were congestive heart failure and placement/removal of a central venous catheter. Patients with PAH-related hospitalizations were more likely to receive parenteral therapy, be in functional class III/IV, and have higher risk scores before hospitalization at enrollment. Following discharge, 25.4% ± 3.2% and 31.0% ± 4.0% of patients with PAH-related and PAH-unrelated first hospitalization, respectively, remained hospitalization-free for 3 years (P = .11). Survival estimates at 3 years postdischarge were 56.8% ± 3.5% and 67.8% ± 3.6% (P = .037) for patients with PAH-related and PAH-unrelated hospitalization, respectively.

Conclusions: In the REVEAL Registry, PAH-related hospitalization was associated with relatively more rehospitalizations and worse survival at 3 years.

Trial registry: ClinicalTrials.gov; No.: NCT00370214; URL: www.clinicaltrials.gov.

Show MeSH
Related in: MedlinePlus