We aimed to evaluate the clinical course and impact of the SARS-CoV-2 pandemic on the rate of diagnosis and therapy in the complete Polish population of patients (pts) with pulmonary arterial hypertension (PAH-1134) and CTEPH (570 pts) treated within the National Health Fund program and reported in the national BNP-PL database. Updated records of 1704 BNP-PL pts collected between March and December 2020 were analyzed with regard to incidence, clinical course and mortality associated with COVID-19. Clinical characteristics of the infected pts and COVID-19 decedents were analyzed. The rates of new diagnoses and treatment intensification in this period were studied and collated to the proper intervals of the previous year. The incidence of COVID-19 was 3.8% (n = 65) (PAH, 4.1%; CTEPH, 3.2%). COVID-19-related mortality was 28% (18/65 pts). Those who died were substantially older and had a more advanced functional WHO class and more cardiovascular comorbidities (comorbidity score, 4.0 ± 2.1 vs. 2.7 ± 1.8; p = 0.01). During the pandemic, annualized new diagnoses of PH diminished by 25–30% as compared to 2019. A relevant increase in total mortality was also observed among the PH pts (9.7% vs. 5.9% pre-pandemic, p = 0.006), whereas escalation of specific PAH/CTEPH therapies occurred less frequently (14.7% vs. 21.6% pre-pandemic). The COVID-19 pandemic has affected the diagnosis and treatment of PH by decreasing the number of new diagnoses, escalating therapy and enhancing overall mortality. Pulmonary hypertension is a risk factor for worsened course of COVID-19 and elevated mortality.
Introduction COVID-19 pandemic has caused not only an increase in overall and cardiovascular mortality, but also hindered access to health care, diagnosis and treatment of diseases other than coronavirus infection. Aim Assessment of the impact of the SARS-CoV-2 pandemic on the rate of diagnosis and therapy of pulmonary hypertension (PH) in Poland, along with an analysis of the incidence and course of COVID-19 among patients (pts) diagnosed with PH, treated under the National Health Fund program, registered in the national BNP-PL database. Methods The records of the complete population of Polish pts treated under the National Drug Program of PH (PAH and CTEPH), registered in the national database of BNP-PL, updated on an ongoing basis by all PH centers, were analyzed. The frequency of SARS-CoV-2 infections, the clinical severity of their course and the mortality were reviewed, taking into account the specific therapies used. The basic clinical characteristics of the group of sick and deceased patients were compared to the remaining patients registered in the BNP-PL database. The rate of increase of new diagnoses ended with inclusion in the Drug Program between March and December 2020, compared to the corresponding periods of the previous year, and the change in the treatment profile were compared. Results The analysis included 1704 pts (PAH 1134, CTEPH 570). The incidence of SARS-CoV-2 infections was 3.8% (n=65), including PAH 2.7% (n=46) and CTEPH 3,2% (n=18). 32 patients (49%) required hospitalization. Mortality rate was 28% (18/65) – including 7/18 outside of hospital. Those who died due to COVID-19 were older (mean age 68.4±15.8 vs. 50.8±18.8 yrs; p<0,001), had higher WHO class and more cardiovascular comorbidities (4±2,06 vs. 2,66±1,8; p=0,01) (Table 1). During the pandemic the number of new diagnoses of PH markedly decreased compared to the corresponding period in 2019 (total 150 vs. 203, PAH 90 vs. 123, CTEPH 60 vs. 80, respectively). A significant increase in total mortality was also observed in the PH group (9,72 vs. 5,85%). Moreover, escalation of specific PH therapy decreased significantly (14,7% vs. 21,6%). Incidence of COVID-19 study group was lower than estimated for general Polish adult population (3,8% vs. 6,5%). Conclusions COVID-19 pandemic deeply influenced the diagnostic and therapeutic process of pulmonary hypertension by reducing the number of new diagnoses, escalation therapy and increased overall mortality in this population. This may be due in part to the conversion of some PAH centers into hospitals treating patients infected with SARS-CoV-2, as well as to patients' fear of admitting to hospital despite clinical deterioration. Pulmonary hypertension is linked to markedly increased mortality in COVID-19, similarly for PAH and CTEPH. Intriguing finding of lower infection rate may be linked to protective lifestyle or specific therapies. Funding Acknowledgement Type of funding sources: None.
Introduction: SARS-CoV-2 infection leads to a hypercoagulable state. The prevalence of pulmonary embolism (PE) seems to be higher in this subgroup of patients. Patients and methods: We combined data from two tertiary referral centers specialized in the management of PE. The aims of this study were as follows: (1) to evaluate the prevalence of PE among a large population of consecutive patients admitted for COVID-19 pneumonia in two centers, (2) to identify a plasma D-dimer threshold that may be useful in PE diagnostic assessment, (3) to characterize the abnormalities associated with PE and mortality in COVID-19 patients. Results: The incidence of symptomatic acute PE was 19.3%. For diagnosing PE in COVID-19 patients, based on ROC curve analysis, we identified a D-dimer concentration/patient’s age ratio of 70, which improved D-dimer diagnostic capacity for PE and led to a reclassification improvement of 14% (NRI 0.14, p = 0.03) when compared to a cut-off level of 1000 ng/mL. Especially in severe COVID-19 lung involvement, D-dimer/age ratio cut-off equal to 70 was characterized by high diagnostic feasibility (sensitivity, specificity, negative predictive value, positive predictive value of 83%, 94%, 96%, and 73%, respectively). Apart from PE status, lung involvement and troponin T concentration were also independent predictors of in-hospital mortality. In the subgroup of PE patients, mortality was comparable with non-PE patients (19/88 (21.5%) vs. 101/368 (27.4%) for non-PE, p = 0.26) and was associated with older age, higher Bova scores, and higher troponin T concentrations. Age was the sole independent predictor for mortality in this subgroup. Conclusions: PE in COVID-19 patients is common, but it may not influence mortality when managed at a specialized center. In suspected PE, age-adjusted D-dimer levels (upper limit of normal obtained from the formula patient’s age × 70) may still be a useful tool to start the diagnostic workup. In COVID-19 patients without PE, older age, more extensive parenchymal involvement, or higher D-dimer levels are factors predicting mortality.
Introduction Pulmonary hypertension (PH) patients may be vulnerable to SARS-CoV-2 infection, but large analytic studies on morbidity and mortality risks are limited. Aim Assessment of the incidence and course of COVID-19 among patients (pts) diagnosed with PH, treated under the NFZ program, registered in the national BNP-PL database with the assessment of the impact of the SARS-CoV-2 pandemic on the care of patients with pulmonary hypertension in Poland. Methods We analyzed the records of the complete population of Polish pts treated under the National Drug Program of PH (PAH and CTEPH), registered in the national database of BNP-PL, and updated on an ongoing basis by all PH centers. The frequency of SARS-CoV-2 infections, clinical severity of COVID-19 course and mortality were reviewed. Clinical characteristics of infected and deceased patients were compared to the remaining patients registered in the BNP-PL database. The rate of increase of new diagnoses ended with inclusion in the Drug Program between 01 March 2020 and 31 August 2021, compared to the pre-pandemic year 2019, and the change in the treatment profile were reviewed. Results The analysis included 1923 pts (PAH 1292, CTEPH 631). The incidence of SARS-CoV-2 infections was 7.4% (n=143) and similar to general population (7.6%), with a slight preponderance in PAH 8.1% (n=105) vs. CTEPH 6.0% (n=38) (p=0.099). 47 patients (33%) required hospitalization. Mortality rate was 24% (34/143) vs. 2.6% for general population – including 19/34 outside of hospital. Those who died due to COVID-19 were older (mean age 56±17.6 vs. 70.5±12.8 yrs; p<0.0001) and had more cardiovascular comorbidities (1.35 vs. 1.97; p=0.01). Systemic arterial hypertension was the strongest unique risk factor for mortality, present in 71% decedents vs. 45% of survivors, and the only independent risk factor in multivariate logistic regression analysis (OR 2.94, 95% CI 1.28–6.73). Moreover, there was a trend towards a higher incidence of diabetes and coronary artery disease in the group of non-survivors (Table 1). The number of new diagnoses of PH decreased during the pandemic compared to 2019 (new diagnoses rate in 2019 was 28.2/month vs. 19.2/month during COVID). A significant increase in total mortality was also observed in the PH group (11.1/month in 2019 vs. 13.7/month during COVID). Escalation of specific PH therapy also reduced (rate of specific therapy escalation in 2019 was 30.4/month vs. 20.5/month during COVID). Conclusions The COVID-19 pandemic has deeply affected the care of patients with pulmonary hypertension by reducing the number of new diagnoses, escalation of therapy, and increasing overall mortality in this population, and this impact continues into second year of pandemics. Pulmonary hypertension is associated with a more severe course and higher mortality in COVID-19. Funding Acknowledgement Type of funding sources: None.
Introduction Classic risk factors of atherosclerosis may contribute to cardiovascular (CV) risk in patients (pts) with pulmonary hypertension associated with congenital heart disease (PAH-CHD), but their prevalence is poorly studied. Purpose We evaluated a large cohort of Polish PAH-CHD patients (PAHpts) treated with specific therapies with regard to prevalence of classic risk factors for atherosclerosis. Methods A multicenter observational snapshot registry was conducted under the auspices of Polish Cardiac Society to study PAH pts, identified in centers treating >5 such pts in years 2008–2018. The analysis included 250 PAH-CHD pts, including non-corrected CHD – predominantly Eisenmenger Syndrome (Gr. 1, 224 pts, mean age 42±2 years, 63% females) and pts after heart disease correction (Gr. 2, 26 pts, mean age 42±6.5 years, 62% females). The incidence of classic CV risk factors was compared in both groups. Results The prevalence of risk factors was considerable considering young age of the cohort and statistically similar in both groups (Figure). Hypertension was present in 14% in Gr. 1 and 15% in Gr. 2. The incidence of diabetes was comparable in both groups (3% vs. 4%). Hyperlipidemia was nearly numerically twice as frequent in Gr. 1 (23% vs. 12%, p=0.18). Current smokers (1%) were only present in Gr. 1, while history of smoking was 4% in both groups. Symptomatic atherosclerosis of peripheral arteries was twice as frequent in Gr. 1 (8% vs. 4%, p=0,71). There was no difference regarding prior stroke (3,6% vs 4%, p=0,63). Chronic kidney disease and atrial fibrillation were one and a half more often in Gr. 1 (respectively, 12% vs. 8%, p=0,81; 12% vs. 8%, p=0.75). Mean heart rate was 72±2 bpm in Gr. 1 and 77±7 bpm in Gr. 2. Gastrointestinal bleeding was reported only in Gr. 1 (2.7%). SCORE calculated risks were low due to low age, but high risk was identified in 9.3% of Gr. 1 and 20% of Gr. 2 (p=0.096). Conclusions Based on our data from national survey, classic atherosclerosis CV risk factors are not uncommon in the population of relatively young patients with PAH-CHD, parallel to improved longevity. Selected pts from both groups present with elevated risk of death from atherosclerotic complications. This finding may influence the overall mortality risk in PAH-CHD population and reflects new challenges in management despite progress in specific therapies of pulmonary hypertension. FUNDunding Acknowledgement Type of funding sources: None. Figure 1
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