Pulmonary Vascular Disease: Pulmonary Vascular Disease - PE/DVT |

In-Hospital Outcome in Patients With PAH or Chronic Thromboembolic Pulmonary Hypertension in Cardiogenic Shock FREE TO VIEW

Taeha Kim, MD; Barry Howe, MD
Author and Funding Information

Dartmouth-Hitchcock Medical Center, Lebanon, NH

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;150(4_S):1187A. doi:10.1016/j.chest.2016.08.1296
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SESSION TITLE: Pulmonary Vascular Disease - PE/DVT

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 26, 2016 at 01:30 PM - 02:30 PM

PURPOSE: Right ventricular failure is the most common cause of death in patients with pulmonary hypertension. In this patient population, cardiogenic shock is most commonly seen in patients with pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH). The aim of this study is to compare the in-hospital patient characteristics and outcomes in cardiogenic shock in patients with and without PAH/CTEPH from a large national database.

METHODS: Using the 2012 National Inpatient Sample (NIS), admissions with the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) code for cardiogenic shock (ICD-9-CM 785.51) were extracted, and data collected on age, sex, length of stay (LOS), mortality, disposition at discharge, associated diagnoses and procedures. Subgroup analysis was performed in those patients with PAH or CTEPH (ICD-9-CM 416.0, 416.8 and 416.9) to compare the outcomes and patient characteristics between those with and without PAH/ CTEPH. Chi-square test and t-test were performed with 95% confidence interval and p-values where applicable. Multivariate regression was performed on associated procedures.

RESULTS: Of the 7,296,968 admissions in the 2012 NIS, 20,211 were associated with cardiogenic shock, and of these 2,537 were associated with PAH/CTEPH. Patients with and without PAH/CTEPH were of similar age (66 years; p=0.8). PAH/CTEPH was associated with relative female predominance (45% vs 38%; p<0.0001), longer mean LOS (13.7 days vs 10.8 days; p=0.006), lower inpatient mortality (35% vs 39%; OR 0.85, 95% CI 0.77, 0.93; p=0.0004) and higher rate of discharge home rather than another facility (37% vs 34%; OR 1.17, 95% CI 1.07, 1.27; p=0.0005). Multivariate regression showed incidence of CPR and vasopressor support were similar in cardiogenic patients with and without PAH/CTEPH. PAH/CTEPH patients were more like to undergo pulmonary artery catheter placement (OR 2.00; 95% CI 1.75, 2.29; p<0.0001) and hemodialysis (OR 1.40; 95% CI 1.23, 1.58; p<0.0001). PAH/CTEPH patients were less likely to undergo left heart catheterization (OR 0.37; 95% CI 0.33, 0.42; p<0.0001) and mechanical ventilation (OR 0.76; 95% CI 0.68, 0.85; p<0.0001).

CONCLUSIONS: PAH/CTEPH patients had longer mean LOS, which may be due to less experience in providers treating this particular subgroup of patient population in cardiogenic shock. PAH/CTEPH patients were more likely to undergo pulmonary artery catheter placement and hemodialysis, which may reflect a higher degree of difficulty in fluid management in this patient population. Those without PAH/CTEPH were more likely to undergo left heart catheterization, which may reflect a higher incidence of acute coronary syndrome in this patient population.

CLINICAL IMPLICATIONS: Superior outcomes in terms of mortality and disposition in PAH/CTEPH patients in cardiogenic shock may indicate LOS in this patient population can be significantly improved and warrant further study on treatment strategies.

DISCLOSURE: The following authors have nothing to disclose: Taeha Kim, Barry Howe

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