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. 2017 Oct-Dec;7(4):758-767.
doi: 10.1177/2045893217726063. Epub 2017 Aug 22.

Multispecialty pulmonary hypertension clinic in the VA

Matthew Jankowich  1   2 , Ryan Hebel  1 , Jennifer Jantz  3 , Siddique Abbasi  1   4 , Gaurav Choudhary  1   4
Affiliations

Multispecialty pulmonary hypertension clinic in the VA

Matthew Jankowich et al. Pulm Circ. 2017 Oct-Dec.

Abstract

Pulmonary hypertension (PH) is often associated with cardiopulmonary co-morbidities, especially in older adults. A multispecialty approach to suspected PH is recommended, but there are few data on adherence to guidelines or outcomes in such patients. This was a single-center retrospective study of consecutively evaluated Veteran patients with suspected PH evaluated in a multispecialty PH clinic at a Veterans Affairs Medical Center, evaluating clinical characteristics, workup outcomes, and prognosis. The referral population (n = 125) was older (mean ± SD age = 73.6 ± 9.8 years) with frequent co-morbidities (e.g. COPD 60%) and obesity (mean ± SD BMI = 32.8 ± 8.1 kg/m2). Of 94 patients undergoing right heart catheterization (RHC), 73 (78%) had confirmed PH (mean pulmonary artery pressure ≥ 25 mmHg). PH was associated with higher BMIs (odds ratio [95% CI] for PH per 1 unit increase = 1.10 [1.02-1.19]) and brachial pulse pressures (odds ratio per 1 mmHg increase = 1.07 [1.02-1.13]). Seventy out of 73 were classifiable by WHO PH groupings. Most patients underwent guideline-recommended PH evaluation. Observed one-year mortality was high (17.8%); the one-year hospitalization rate was 34.2%. These results compare favorably to observations from the VA Clinical Assessment, Reporting, and Tracking cohort of Veterans with PH by RHC (19.1% and 60.9% one-year mortality and hospitalization rates, respectively). Multispecialty PH clinic evaluation revealed a high prevalence of co-morbidities in veterans with suspected PH; PH was prevalent in this referral population. PH patients had significant morbidity and mortality but supportive care measures improved following PH evaluation. Further prospective randomized study is needed to determine if a multispecialty clinic approach improves PH morbidity and mortality in veterans.

Keywords: multispecialty clinic; pulmonary hypertension; veterans.

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Figures

Fig. 1.
Fig. 1.
Kaplan–Meier survival estimate for patients with PH by RHC. Analysis time is in days.
See this image and copyright information in PMC

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