PURPOSE: Pulmonary hypertension (PH) is associated with significant morbidity and mortality. While new therapies have resulted in improved survival, they can be costly and primarily limited to specialty centers. Few studies have examined socioeconomic disparities and outcomes in PH. We are reporting the PH experience in a socioeconomically disadvantaged population.
METHODS: A retrospective chart review of PH patients (confirmed by right-heart catheterization) since 2006 at a public county hospital system. We collected demographic, socioeconomic, and clinical data; we also evaluated therapies, referral patterns, and clinical outcomes.
RESULTS: During the study period, 43 patients with PH were identified. The median follow-up time was 2 years. At diagnosis, their mean age was 47 ± 12.4 years; two-thirds were female. Nearly half (47%) self-identified as Hispanic/Latino. Most patients had medicaid or public county insurance (56%). Pulmonary arterial hypertension (PAH) was the most frequent cause of PH (49%); most commonly drugs and toxins associated PAH (57%). Left-heart dysfunction was the most common cause of non-PAH PH. At presentation, 60% of patients had New York Heart Association Class III symptoms. Mean values during right heart catheterization were 49.4 mmHg for mean pulmonary artery pressure; 4.6 L/min for cardiac output, and 700 dsc-5 for pulmonary vascular resistance. PAH patients were most commonly treated with sildenafil (74%). However, poor compliance with sildenafil therapy was common (59%), defined as missing ≥ 2 weeks of medication. Two-thirds of patients missed at least 2 PH clinic visits per year. 12 patients were referred to a PH center and 75% of those made it to their follow-up visit. The mean number of hospital visits was 0.73 within one year of diagnosis. A total of 9 patients died during follow-up (21%); nearly all deaths resulted from PH (89%).
CONCLUSIONS: The morbidity and mortality associated with PH in a socioeconomically disadvantaged population is high. While the exact reasons are unclear, this may partly result from inadequate access to and poor compliance with PH treatment.
CLINICAL IMPLICATIONS: To describe the barriers to implementation of costly and complex PH therapies in a marginal patient cohort.
DISCLOSURE: Roham Zamanian: Grant monies (from industry related sources): Roham Zamanian receives grant support from Gilead, United Therapeutics, and Actelion., Consultant fee, speaker bureau, advisory committee, etc.: Roham Zamanian receives consulting fees from Gilead and Ikaria., Other: Roham Zamanian serves on the advisory board of United Therapeutics.
The following authors have nothing to disclose: Shanti Shenoy, Vincent Liu, Hau Liu, Eric Hsiao, John Wehner
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