Diagnosis of pulmonary hypertension in the congenital heart disease adult population impact on outcomes

The aim of this study was to assess the impact of the diagnosis of pulmonary hypertension (PH) on mortality, morbidity, and health services utilization (HSU) in an adult congenital heart disease (CHD) population. Although PH is a well-recognized complication of CHD, population-based studies of its s...

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Vydané v:Journal of the American College of Cardiology Ročník 58; číslo 5; s. 538
Hlavní autori: Lowe, Boris S, Therrien, Judith, Ionescu-Ittu, Raluca, Pilote, Louise, Martucci, Giuseppe, Marelli, Ariane J
Médium: Journal Article
Jazyk:English
Vydavateľské údaje: United States 26.07.2011
Predmet:
Adult
Aged
Ambulatory Care - utilization
Arrhythmias, Cardiac - mortality
Cardiac Catheterization - utilization
Echocardiography - utilization
Emergency Service, Hospital - utilization
Female
Heart Defects, Congenital - mortality
Heart Failure - mortality
Hospitalization - statistics & numerical data
Humans
Hypertension, Pulmonary - diagnosis
Hypertension, Pulmonary - mortality
Intensive Care Units - utilization
Longitudinal Studies
Male
Middle Aged
Multivariate Analysis
Prevalence
Retrospective Studies
Risk
United States - epidemiology
United States
ISSN:1558-3597, 1558-3597
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Popis
Shrnutí:The aim of this study was to assess the impact of the diagnosis of pulmonary hypertension (PH) on mortality, morbidity, and health services utilization (HSU) in an adult congenital heart disease (CHD) population. Although PH is a well-recognized complication of CHD, population-based studies of its significance on the survival and functional capacity of patients are uncommon. A retrospective longitudinal cohort study was conducted in an adult CHD population with 23 years of follow-up, from 1983 to 2005. The prevalence of PH was measured in 2005. Mortality, morbidity, and HSU outcomes were compared between patients with and without diagnoses of PH using multivariate Cox (mortality and morbidity) and Poisson (HSU) regression models within a subcohort matched for age and CHD lesion type. Of 38,430 adults alive with CHD in 2005, 2,212 (5.8%) had diagnoses of PH (median age 67 years, 59% women). The diagnosis of PH increased the all-cause mortality rate of adults with CHD more than 2-fold compared with patients without PH (hazard ratio [HR]: 2.69; 95% confidence interval [CI]: 2.41 to 2.99). Morbid complications including heart failure and arrhythmia occurred with a 3-fold higher risk compared with patients without PH (HR: 3.01; 95% CI: 2.80 to 3.22). The utilization of inpatient and outpatient services was increased, especially cardiac catheterization, excluding the index diagnostic study (rate ratio: 5.04; 95% CI: 4.27 to 5.93) and coronary and intensive care hospitalizations (rate ratio: 5.03; 95% CI: 4.86 to 5.20). A diagnosis of PH in adults with CHD is associated with a more than 2-fold higher risk for all-cause mortality and 3-fold higher rates of HSU, reflecting high morbidity.
Bibliografia:ObjectType-Article-1
SourceType-Scholarly Journals-1
ObjectType-Feature-2
content type line 23
ISSN:1558-3597
1558-3597
DOI:10.1016/j.jacc.2011.03.033