PURPOSE:Pulmonary arterial hypertension (PAH) is increasingly being diagnosed in patients with advanced age. We sought to investigate observed versus expected mortality among geriatric idiopathic PAH patients treated with specific PAH therapy.
METHODS:From the University of Connecticut’s Pulmonary Vascular Disease Program database, 20 idiopathic PAH patients over 65 years of age were identified. Patient demographics, cardiopulmonary hemodynamics, PAH therapy, and mortality were retrospectively analyzed. Based on observed follow-up time, the probability of death was calculated for each subject using a prediction formula for PAH patients developed by the National Institutes of Health (NIH). Byar’s method for Poisson counts was used to compare observed and expected tallies of deaths within the study sample. A p value ≤; 0.05 was considered statistically significant.
RESULTS:The mean age of the 20 geriatric idiopathic PAH patients was 77 years (+/− 6.6) of which 70% were female. The mean cardiopulmonary hemodynamic values for the cohort were: right atrial pressure: 9.7 mmHg (+/− 4.5); mean pulmonary artery pressure: 45.2 mmHg (+/− 8.9); pulmonary artery occlusion pressure: 12.1 mmHg (+/− 3.6); cardiac index: 2.3 LPM (+/− 0.52); and pulmonary vascular resistance: 698.3 dynes / sec / cm-5 (+/− 312.1). 14 subjects received PAH monotherapy with bosentan, sildenafil, or epoprostenol. 6 subjects received PAH combination therapy with bosentan, sildenafil, iloprost, or treprostinil. Total follow-up across the 20 subjects was 58.7 years, with average follow-up of 2.9 yrs (+/− 1.7) per subject. Based upon the NIH formula, the expected number of deaths for this cohort was 9.4. During follow-up, 3 deaths actually occurred. Thus, observed mortality was only 31.9% of expected (p = 0.03, 95% C.I. = [6.4%, 93.2%]).
CONCLUSION:Efficacy of PAH therapy in geriatric patients is unknown. In this cohort of subjects, the outcomes of older adults treated with specific PAH therapy demonstrates improved survival relative to that predicted by the NIH formula.
CLINICAL IMPLICATIONS:Ambulatory geriatric outpatients diagnosed with idiopathic PAH should be considered for a trial of PAH therapy.
DISCLOSURE:Raymond Foley, University grant monies Actelion Pharmacuticals; Consultant fee, speaker bureau, advisory committee, etc. Actelion Pharmaceuticals; Gilead; Pfizer pharmacuticals; United Therapeutics; No Product/Research Disclosure Information