0
Poster Presentations: Wednesday, October 26, 2011 |

Four-Year Outcomes of Patients With Pulmonary Arterial Hypertension: Risk, Prognosis, and the Disease Duration Continuum FREE TO VIEW

Michael McGoon, MD; A. Frost, MD; Dave Miller, MS; Robyn Barst, MD; C. Gregory Elliott, MD; Harrison Farber, MD; Ginny Lai, MS; Abby Poms, BS; David Badesch, MD; Theodore Liou, MD; Raymond Benza, MD
Chest. 2011;140(4_MeetingAbstracts):724A. doi:10.1378/chest.1119437
Text Size: A A A
Published online

Abstract

PURPOSE: The Registry to EValuate Early And Long-term Pulmonary Arterial Hypertension (PAH) Disease Management (REVEAL) provides information about demographics, clinical course, and management of PAH patients. The compositions of incident and prevalent cohorts are known to differ; however, sample size restraints have previously limited our ability to describe a continuum of risk profiles from recently diagnosed patients to long-term survivors.

METHODS: Datalock was on March 4, 2011. The analyses comprise 3071 REVEAL patients with PAH, ≥18 years at enrollment, and pulmonary capillary wedge pressure ≤15 mm Hg. The analysis cohort was stratified by time from diagnostic right heart catheterization to enrollment [≤90 days (n = 843), >90 days to <1 year (n = 454), ≥1 year to <2 years (n = 423), ≥2 years to <3 years (n = 346), ≥3 years to <5 years (n = 459), and ≥5 years (n = 546)]. Kaplan-Meier estimates ± SE were used to evaluate survival. Descriptive data are mean ± SD.

RESULTS: 4-year survival estimates from enrollment were as follows for the respective groups listed above: 63 ± 3%, 66 ± 3%, 67 ± 3%, 71 ± 3%, 74 ± 2%, and 74 ± 2%. Patient characteristics at enrollment respectively included: functional class (FC) III; 60%, 52%, 52%, 50%, 46%, and 45%; FC IV; 14%, 7%, 7%, 5%, 3%, and 2%; 6-MWD: 310 ± 127, 346 ± 126, 354 ± 126, 379 ± 125, 381 ± 126, and 403 ± 117 m; BNP (median): 230, 161, 156, 121, 83, and 73 pg/mL; mRAP (mean ± SD): 10 ± 6, 10 ± 6, 9 ± 5, 9 ± 5, 9 ± 6, and 8 ± 5 mm Hg. FC, BNP and mRAP were inversely related whereas 6MWD was directly related to estimated survival and disease duration.

CONCLUSIONS: Increased duration of disease prior to enrollment is associated with subsequent survival advantage. This advantage appears to be explained by clinical parameters suggesting that patients with longer survival have milder or more effectively managed disease.

CLINICAL IMPLICATIONS: Although long-term survivors differ “on average” from newly diagnosed patients, there is substantial patient-to-patient variation in clinical characteristics within strata. This highlights the importance of multifactorial risk evaluations to assess long-term prognosis of patients. Future studies are needed to determine whether such profiles warrant individualized treatment regimens.

DISCLOSURE: Michael McGoon: Consultant fee, speaker bureau, advisory committee, etc.: Dr McGoon serves as a consultant with Actelion, Gilead, Lung Rx, and Medtronic, Grant monies (from industry related sources): Dr McGoon has received grants from Gilead and Medtronic, Other: Dr McGoon has received honoraria for his service on the REVEAL Steering Committee, which is supported by Actelion

A. Frost: Consultant fee, speaker bureau, advisory committee, etc.: Dr Frost serves as a consultant for Actelion and Gilead and has received honoraria from Actelion, Gilead, and Pfizer, University grant monies: Dr Frost has received (through Baylor College of Medicine) funds for IRB-approved research from Gilead, Actelion, United Therapeutics, Eli Lilly, Pfizer, Novartis and Bayer, Other: Dr Frost has received honoraria for her service on the REVEAL Steering Committee, which is supported by Actelion

Dave Miller: Other: Dave Miller is employed by ICON Late Phase and Outcomes Research, a company that receives research support from Actelion and other pharmaceutical companies

Robyn Barst: Consultant fee, speaker bureau, advisory committee, etc.: Dr Barst serves as a consultant for and has received honoraria from Actelion, Bayer, GlaxoSmithKline, GeneraMedix, Gilead, Eli Lilly & Co., MondoBIOTECH, NIH/NHLBI, Novartis, and Pfizer, Grant monies (from industry related sources): Dr Barst has received grants from Actelion, Gilead, Eli Lilly & Co., Novartis, Pfizer, and United Therapeutics, Grant monies (from sources other than industry): Dr Barst has received grants from the NIH/NHLBI, Other: Dr Barst has received honoraria for her service on the REVEAL Steering Committee, which is supported by Actelion

C. Gregory Elliott: Grant monies (from industry related sources): Dr Elliott has received grant support from Actelion, Pfizer, Encysive Pharmaceuticals, and United Therapeutics, Other: Dr Elliott has received honoraria for service on the REVEAL Steering Committee, which is supported by Actelion

Harrison Farber: Consultant fee, speaker bureau, advisory committee, etc.: Dr Farber serves as a consultant and is on the speaker’s bureau for Actelion, Other: Dr Farber has received honoraria for service on the REVEAL Steering Committee

Ginny Lai: Other: Ginny Lai is employed by ICON Late Phase and Outcomes Research, a company that receives research support from Actelion and other pharmaceutical companies

Abby Poms: Consultant fee, speaker bureau, advisory committee, etc.: Abby Poms serves as a consultant for clinical research studies and advisory boards for Actelion, Gilead, United Therapeutics, GlaxoSmithKline, and GeneraMedix, and has received honoraria for speaker bureau participation for Actelion, Gilead, and United Therapeutics, Grant monies (from industry related sources): Abby Poms has received grants from United Therapeutics and GlaxoSmithKline

David Badesch: Consultant fee, speaker bureau, advisory committee, etc.: Dr Badesch has received honoraria for service on Steering Committees and/or Advisory Boards for Actelion, Arena, Bayer, Ikaria, Gilead, Encysive Pharmaceuticals, Pfizer, GlaxoSmithKline, Lung Rx, United Therapeutics, Eli Lilly & Co., Biogen Idec, and mondoBIOTECH, Grant monies (from industry related sources): Dr Badesch has received grants from Actelion, Gilead, Encysive Pharmaceuticals, Pfizer, United Therapeutics, Lung Rx, and Eli Lilly & Co., Grant monies (from sources other than industry): Dr Badesch has received grants from the NIH/NHLBI , Other: Dr Badesch has received honoraria for his service on the REVEAL Steering Committee, which is supported by Actelion

Theodore Liou: Grant monies (from sources other than industry): Dr Liou has received grants from the NIH/NHLBI, the Margolis Family Foundation of Utah, and the CF Foundation, Other: Dr Liou has received honoraria for service on the REVEAL Steering Committee, which is supported by Actelion

Raymond Benza: Consultant fee, speaker bureau, advisory committee, etc.: Dr Benza has received honoraria from Actelion, Gilead, and United Therapeutics, Grant monies (from industry related sources): Dr Benza has received or is pending receipt of grants from Actelion, Bayer, Novartis, Pfizer, and United Therapeutics, Grant monies (from sources other than industry): Dr Benza has received or is pending receipt of grants from the AHA and the the NIH/NHLBI , Other: Dr Benza has received honoraria for his service on the REVEAL Steering Committee, which is supported by Actelion

No Product/Research Disclosure Information

09:00 AM - 10:00 AM


Figures

Tables

References

NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Some tools below are only available to our subscribers or users with an online account.

Related Content

Customize your page view by dragging & repositioning the boxes below.

Find Similar Articles
CHEST Journal Articles
PubMed Articles
  • CHEST Journal
    Print ISSN: 0012-3692
    Online ISSN: 1931-3543