Idiopathic Pulmonary Hypertension-Related Hospitalizations Reduced Over 10 Years
Presenter: Bisharah Rizvi, MD, Saint Agnes Medical Center, Fresno, CA.
A summary of the session, Hospitalizations of idiopathic pulmonary arterial hypertension in the United States: a national perspective a decade apart (2007 vs 2017), October 20, 2021, Chest 2021.
Idiopathic pulmonary artery hypertension (IPAH)-related hospitalizations and all-cause mortality related to hospitalization dropped dramatically from 2007 to 2017. In patients with IPAH, hospitalizations contribute to morbidity, mortality, and incur substantial healthcare costs, according to a large, population-based study. “Since 2007, there have been major advances in treatment, but little is known about how these developments have affected the characteristics of IPAH-related hospitalizations,” said Bisharah Rizvi, an investigator for the study.
“For this study, we compared outcomes of hospitalization related to IPAH between 2007 and 2017 using the largest in-patient database in the US, the National Inpatient Sample (NIS),” she said. “We included data on patients 18 years or older on total hospitalizations, demographics, primary payer, bed size, location/teaching status of the hospital, region of hospital, comorbidities, all-cause mortality, median length of stay, and median charges.”
Rizvi noted that results showed a statistically significant decrease in total hospitalizations for IPAH from 17,713 patients in 2007 to 9,330 patients in 2017 (P < .001). IPAH diagnosis was associated with 0.05% of all hospitalizations reviewed in 2007 and 0.03% in 2017. All-cause in-hospital mortality decreased from 2007 (6.4%) to 2017 (4.8%). Length of stay stayed the same, a median 5 days for both years. Total median charges increased from $26,000 to $46,000. Medicare was the primary payer in both years, 67.4% in 2007 and 62.3% in 2017.
The number of female admissions was high in both 2007 (65.2%) and in 2017 (68.4%) when compared with males. Whites had the highest number of hospitalizations for IPAH relative to other races in 2007 and 2017, but the percentage decreased slightly from 67.4% to 64.1%, respectively. Admissions for African Americans and Hispanics slightly increased in percentage from 17.4% to 19.5% and 7% to 9.6%, respectively. Regionally, in Northeast, hospitalizations decreased during the 10 years from 35.4% to 20.9%, but in the Midwest, South, and West, hospitalizations all increased, according to Rizvi.
Rizvi noted that age was an independent predictor of all-cause mortality in hospitals. Patients who were age 45 to 64 years (odds ratio [OR] 2.09) and over 65 years (OR 4.09) had greater rates of mortality compared to those aged 18 to 44, which was expected. “Males had higher rates of mortality than females, even though the percentage of admission for females was higher. Several theories may explain this, including the role of female sex hormones, better response to therapy in women and genetic mutations.”
“Compared to White patients,” she said, “African American and Hispanic patients had lower rates of mortality, which could be due to genetic differences, structural cardiovascular differences, or pharmacogenetic differences and socioeconomic factors. Surprisingly, cardiac arrest increased from 1% in 2007 to 1.6% in 2017.”
In conclusion, Rizvi said, “This is the first large retrospective cohort study of patients with IPAH that compares outcomes of hospitalizations 10 years apart using the NIS database. Data revealed significant reductions in IPAH-related hospitalizations. This could be from significant advances in medical treatment and the availability of new medications, increased awareness of the disease and improved outpatient follow-up and management. We also saw reduced all-cause mortality related to hospitalization, which could be due to better outpatient follow-up, multidisciplinary care and easier availability of medications.”
“Increased healthcare costs could be due to the cost of the 8 newer IPAH medications approved by the FDA since 2007. New drug use during inpatient stays increases costs. Another reason could be increased costs due to the availability of diagnostic imaging.”
Rizvi added that “IPAH is linked to an increased risk of morbidity and mortality. Further epidemiological studies are needed to understand the nuances related to hospitalizations and outcomes for IPAH.”
Disclosures
Bisharah Rizvi, MD: No relevant relationships
Reference
Rizvi B, Desai R, Elwing J, et al. Hospitalizations of idiopathic pulmonary arterial hypertension in the United States: a national perspective a decade apart (2007 vs 2017). Chest 2021; 160(4)(Suppl):A2281–A2282, October 1, 2021. doi: 10.1016/j.chest.2021.07.1996