Anticoagulation in pulmonary arterial hypertension - association with mortality, healthcare utilization, and quality of life: The Pulmonary Hypertension Association Registry (PHAR)

Garry, Jonah D.; Kolaitis, N.A.; Kronmal, Richard A.; Thenappan, Thenappan; Hemnes, Anna R.; Grinnan, Daniel; Bull, Todd; Chakinala, Murali M.; Horn, Evelyn M.; Simon, Marc A.; Marco, Teresa De

doi:10.1016/j.healun.2022.08.019

Cited by 4 publications

(3 citation statements)

References 31 publications

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“…Anticoagulation therapy showed no benefit in mortality regardless of the underlying cause of PH ( P =0.11), in addition to worsening of quality of life (adjusted mean difference of emPHasis-10 score, 1.74 [95% CI, 0.40–3.09]), more ED visits (aIRR, 1.41 [95% CI, 1.28–1.56]), hospitalization (aIRR, 1.33 [95% CI, 1.14–1.55]), and days in the hospital (aIRR, 1.30 [95% CI, 1.23–1.37]). 143…”

Section: Venous Thromboembolism (Deep Vein Thrombosis and Pulmonary E...mentioning

confidence: 99%

2024 Heart Disease and Stroke Statistics: A Report of US and Global Data From the American Heart Association

Martin,

Aday,

Almarzooq

et al. 2024

Circulation

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BACKGROUND: The American Heart Association (AHA), in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, nutrition, sleep, and obesity) and health factors (cholesterol, blood pressure, glucose control, and metabolic syndrome) that contribute to cardiovascular health. The AHA Heart Disease and Stroke Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, brain health, complications of pregnancy, kidney disease, congenital heart disease, rhythm disorders, sudden cardiac arrest, subclinical atherosclerosis, coronary heart disease, cardiomyopathy, heart failure, valvular disease, venous thromboembolism, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs). METHODS: The AHA, through its Epidemiology and Prevention Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States and globally to provide the most current information available in the annual Statistical Update with review of published literature through the year before writing. The 2024 AHA Statistical Update is the product of a full year’s worth of effort in 2023 by dedicated volunteer clinicians and scientists, committed government professionals, and AHA staff members. The AHA strives to further understand and help heal health problems inflicted by structural racism, a public health crisis that can significantly damage physical and mental health and perpetuate disparities in access to health care, education, income, housing, and several other factors vital to healthy lives. This year’s edition includes additional global data, as well as data on the monitoring and benefits of cardiovascular health in the population, with an enhanced focus on health equity across several key domains. RESULTS: Each of the chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics. CONCLUSIONS: The Statistical Update represents a critical resource for the lay public, policymakers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.

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Section: Venous Thromboembolism (Deep Vein Thrombosis and Pulmonary E...mentioning

confidence: 99%

2024 Heart Disease and Stroke Statistics: A Report of US and Global Data From the American Heart Association

Martin,

Aday,

Almarzooq

et al. 2024

Circulation

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“…Once diagnosed, lifelong anticoagulation therapy is recommended in patients with CTEPH if there is no contraindication to anticoagulation, and CTEPH patients receiving new oral anticoagulants present a similar or lower incidence of major bleeding compared with vitamin K antagonists but an increased risk of recurrent venous thromboembolism [ 36 , 37 ]. However, among PAH patients receiving anticoagulation, the Pulmonary Hypertension Association Registry disclosed that anticoagulation was not associated with higher mortality but was associated with a poorer quality of life and increased emergency department visits, hospitalizations, and hospital days [ 38 ]. At present, most studies use warfarin as an anticoagulant, and there is still a paucity of relevant data on the effect of new oral anticoagulant on the prognosis of PAH patients.…”

Section: Pharmacological Therapy For Pahmentioning

confidence: 99%

Medical Management of Pulmonary Arterial Hypertension: Current Approaches and Investigational Drugs

et al. 2023

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Pulmonary arterial hypertension (PAH) is a malignant pulmonary vascular syndrome characterized by a progressive increase in pulmonary vascular resistance and pulmonary arterial pressure, which eventually leads to right heart failure and even death. Although the exact mechanism of PAH is not fully understood, pulmonary vasoconstriction, vascular remodeling, immune and inflammatory responses, and thrombosis are thought to be involved in the development and progression of PAH. In the era of non-targeted agents, PAH had a very dismal prognosis with a median survival time of only 2.8 years. With the deep understanding of the pathophysiological mechanism of PAH as well as advances in drug research, PAH-specific therapeutic drugs have developed rapidly in the past 30 years, but they primarily focus on the three classical signaling pathways, namely the endothelin pathway, nitric oxide pathway, and prostacyclin pathway. These drugs dramatically improved pulmonary hemodynamics, cardiac function, exercise tolerance, quality of life, and prognosis in PAH patients, but could only reduce pulmonary arterial pressure and right ventricular afterload to a limited extent. Current targeted agents delay the progression of PAH but cannot fundamentally reverse pulmonary vascular remodeling. Through unremitting efforts, new therapeutic drugs such as sotatercept have emerged, injecting new vitality into this field. This review comprehensively summarizes the general treatments for PAH, including inotropes and vasopressors, diuretics, anticoagulants, general vasodilators, and anemia management. Additionally, this review elaborates the pharmacological properties and recent research progress of twelve specific drugs targeting three classical signaling pathways, as well as dual-, sequential triple-, and initial triple-therapy strategies based on the aforementioned targeted agents. More crucially, the search for novel therapeutic targets for PAH has never stopped, with great progress in recent years, and this review outlines the potential PAH therapeutic agents currently in the exploratory stage to provide new directions for the treatment of PAH and improve the long-term prognosis of PAH patients.

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“…Für weitere Formen der PH wie die PAH bei angeborenen Herzfehlern oder Patient*innen mit i. v. Prostazyklintherapie liegen ebenfalls keine Daten vor. Die Entscheidung für oder gegen eine (therapeutische) Antikoagulation sollte daher individuell, auch unter Berücksichtigung eines erhöhten Blutungsrisikos, erfolgen.Kommentar: Neue Registerdaten des PHAR-Registers aus den USA deuten auf einen Zusammenhang einer erhöhten Hospitalisierungsrate und einer schlechteren Lebensqualität bei Patient*innen mit Gruppe-1-PH (idiopathische/hereditäre/medikamenten-und toxininduzierte PAH, Kollagenose-assoziierte PAH, HIV-induzierte PAH, pulmonal veno-okklusive Erkrankung), die eine Antikoagulation erhalten, hin[13]. Somit besteht ein weiterer Forschungsbedarf.Diuretische TherapieDie Rechtsherzinsuffizienz führt zu einer Volumenretention, mit reduziertem renalem Blutfluss sowie Aktivierung des Renin-Angiotensin-Aldosteron-Mechanismus.…”

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Allgemeine Maßnahmen und Management der pulmonalarteriellen Hypertonie

Lichtblau,

Harutyunova,

Nechwatal

et al. 2023

Pneumologie

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ZusammenfassungDie Betreuung von Patienten mit pulmonalarterieller Hypertonie (PAH) erfordert ein multimodales Konzept und Management vielschichtiger Maßnahmen, die die medikamentöse Therapie für das Management von Nebenwirkungen und der Rechtsherzinsuffizienz umfassen sowie die Aufklärung u. a. über Schwangerschaft und Flugreisen, psychosoziale Unterstützung, körperliches Training und Prophylaxe durch Impfungen.Positive Studienergebnisse haben zu einer gesteigerten Empfehlung eines spezifischen Trainings bei pulmonaler Hypertonie geführt. Auch wurde die Empfehlung zur Eisengabe auf die aktuelle Evidenzlage angepasst.Besonderen Fokus hat in den aktuellen Leitlinien die Ausarbeitung der Empfehlungen zu Schwangerschaftsaufklärung und Verhütung sowie dem Management einer Schwangerschaft erhalten. In diesem Artikel soll ein Überblick über die Empfehlungen zu allgemeinen Maßnahmen und zum Management der PAH gemäß ESC/ERS-Leitlinien gegeben werden. Ergänzungen der Leitlinienempfehlungen wurden durch die Autoren als Kommentare gekennzeichnet.

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Anticoagulation in pulmonary arterial hypertension - association with mortality, healthcare utilization, and quality of life: The Pulmonary Hypertension Association Registry (PHAR)

Cited by 4 publications

References 31 publications

2024 Heart Disease and Stroke Statistics: A Report of US and Global Data From the American Heart Association

2024 Heart Disease and Stroke Statistics: A Report of US and Global Data From the American Heart Association

Medical Management of Pulmonary Arterial Hypertension: Current Approaches and Investigational Drugs

Allgemeine Maßnahmen und Management der pulmonalarteriellen Hypertonie

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