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. 2020 Jul;158(1):330-340.
doi: 10.1016/j.chest.2020.01.046. Epub 2020 Feb 25.

Outcomes of Pulmonary Arterial Hypertension Are Improved in a Specialty Care Center

Hongyang Pi  1 , Chad M Kosanovich  1 , Adam Handen  2 , Michael Tao  1 , Jacqueline Visina  3 , Gabrielle Vanspeybroeck  1 , Marc A Simon  4 , Michael G Risbano  5 , Aken Desai  6 , Michael A Mathier  4 , Belinda N Rivera-Lebron  5 , Quyen Nguyen  5 , Jennifer Kliner  4 , Mehdi Nouraie  7 , Stephen Y Chan  8
Affiliations

Outcomes of Pulmonary Arterial Hypertension Are Improved in a Specialty Care Center

Hongyang Pi et al. Chest. 2020 Jul.

Abstract

Background: Pulmonary arterial hypertension (PAH) is characterized by elevated pulmonary arterial pressures and is managed by vasodilator therapies. Current guidelines encourage PAH management in specialty care centers (SCCs), but evidence is sparse regarding improvement in clinical outcomes and correlation to vasodilator use with referral.

Research question: Is PAH management at SCCs associated with improved clinical outcomes?

Study designand methods: A single-center, retrospective study was performed at the University of Pittsburgh Medical Center (UPMC; overseeing 40 hospitals). Patients with PAH were identified between 2008 and 2018 and classified into an SCC or non-SCC cohort. Cox proportional hazard modeling was done to compare for all-cause mortality, as was negative binomial regression modeling for hospitalizations. Vasodilator therapy was included to adjust outcomes.

Results: Of 580 patients with PAH at UPMC, 455 (78%) were treated at the SCC, comprising a younger (58.8 vs 64.8 years; P < .001) and more often female (68.4% vs 51.2%; P < .001) population with more comorbidities without differences in race or income. SCC patients demonstrated improved survival (hazard ratio, 0.68; P = .012) and fewer hospitalizations (incidence ratio, 0.54; P < .001), and provided more frequent disease monitoring. Early patient referral to SCC (< 6 months from time of diagnosis) was associated with improved outcomes compared with non-SCC patients. SCC patients were more frequently prescribed vasodilators (P < .001) and carried more diagnostic PAH coding (P < .001). Vasodilators were associated with improved outcomes irrespective of location but without statistical significance when comparing between locations (P > .05).

Interpretation: The UPMC SCC demonstrated improved outcomes in mortality and hospitalizations. The SCC benefit was multifactorial, with more frequent vasodilator therapy and disease monitoring. These findings provide robust evidence for early and regular referral of patients with PAH to SCCs.

Keywords: compliance; pulmonary arterial hypertension; quality of care; specialty care center; vasodilator.

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Figures

Figure 1
Figure 1
Specialty care center (SCC) patients displayed improved mortality compared with non-SCC counterparts. A, Adjusted cumulative survival among patients treated at SCCs vs non-SCC patients. B, Postestimation plot from Cox model to compare survival of patients referred early to SCCs (within 6 months of diagnosis) and non-SCC patients. RHC = right-sided heart catheterization.
Figure 2
Figure 2
A and B, Crude cumulative survival curves for male (A) and female (B) patients treated at SCC vs non-SCC. See Figure 1 legend for expansion of abbreviations.
See this image and copyright information in PMC

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