Health Disparities in Patients with Pulmonary Arterial Hypertension: A Blueprint for Action. An Official American Thoracic Society Statement

Talwar, Arunabh; Garcia, Joe G.N.; Tsai, Halley; Moreno, Matthew R.; Lahm, Tim; Zamanian, Roham T.; Machado, Roberto F.; Kawut, Steven M.; Selej, Mona; Mathai, Stephen C.; DʼAnna, Laura Hoyt; Sahni, Sonu; Rodriquez, Erik J.; Channick, Richard N.; Fagan, Karen A.; Gray, Michael P.; Armstrong, Jessica; Lopez, Josanna Rodriguez; Perez, Vinicio de Jesus

doi:10.1164/rccm.201709-1821st

Cited by 40 publications

(57 citation statements)

References 130 publications

(121 reference statements)

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“…Regardless, prior analysis using ZIP code analysis within the REVEAL registry showed that lower income groups had a longer time to disease recognition and that there were more functional class 3−4 patients in lower income groups at the time of diagnosis. 32 Black and Hispanic races were reported at a higher frequency in the lower 2 income categories compared with the higher 2 income categories. 32 Although these findings might suggest that outcomes should be worse in the black and Hispanic groups, this was not borne out in this analysis.…”

Section: Discussionmentioning

confidence: 87%

“…32 Black and Hispanic races were reported at a higher frequency in the lower 2 income categories compared with the higher 2 income categories. 32 Although these findings might suggest that outcomes should be worse in the black and Hispanic groups, this was not borne out in this analysis. It is unclear that adjusting for socioeconomic status Survival analysis limited to patients aged ≤ 60 years, using left truncation analysis.…”

Section: Discussionmentioning

confidence: 87%

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Impact of race on survival in pulmonary arterial hypertension: Results from the REVEAL registry

Medrek

Sahay

Zhao

et al. 2020

The Journal of Heart and Lung Transplantation

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BACKGROUND: Prior research has suggested that the prevalence and outcomes of pulmonary arterial hypertension (PAH) may vary by race or ethnicity. However, these studies have been limited by small sample size or methodological techniques relying on epidemiologic data. The purpose of this study is to evaluate the relationship between race/ethnicity and survival in a large U.S.-based prospective multicenter registry. METHODS: Patients in the Registry to Evaluate Early and Long-term PAH Disease Management (REVEAL), a 5-year observational study of Group 1 PAH, were categorized by race/ethnicity. Baseline hemodynamic characteristics, clinical characteristics, and medication use was described. The relationship between race/ethnicity and outcome was evaluated by Kaplan−Meier and Cox proportional hazards modeling techniques. Left-truncation analysis, which adjusted for time from diagnosis to study enrollment, was used to minimize the effect of survivor bias. RESULTS: This analysis included 3,046 patients; 2,202 identified as white, 393 as black, 263 as Hispanic, 100 as Asian or Pacific Islander, and 88 as other. Unadjusted Kaplan−Meier survival analysis indicated that white patients had the lowest survival rates. After adjusting for variables of prognostic impact, race/ethnicity was no longer significantly associated with survival. Other results showed that black patients were more likely to have connective tissue disease−associated PAH, Hispanic patients were more likely to have portopulmonary hypertension, and Asian patients were more likely to have congenital heart disease−associated PAH. CONCLUSIONS: Analysis of the REVEAL registry did not find race/ethnicity to be a significant predictor of mortality. This is the largest analysis to date evaluating the role of race/ethnicity on outcomes in PAH.

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Section: Discussionmentioning

confidence: 87%

Section: Discussionmentioning

confidence: 87%

Impact of race on survival in pulmonary arterial hypertension: Results from the REVEAL registry

Medrek

Sahay

Zhao

et al. 2020

The Journal of Heart and Lung Transplantation

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“…These observations suggest that molecular, genetic, and environmental factors may all predispose AAs to PH and warrant further study to shed insight on PH pathophysiology or to identify at-risk individuals. 46 …”

Section: Discussionmentioning

confidence: 99%

Racial differences in patients referred for right heart catheterization and risk of pulmonary hypertension

et al. 2018

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African Americans (AA) have a higher incidence of pulmonary hypertension (PH) risk factors. Few studies have examined the racial differences in the prevalence and etiology of PH and direct comparison of invasive hemodynamics between AAs and Caucasians has rarely been reported. In this study, we examined whether racial differences exist in patients referred for right heart catheterization (RHC) and hypothesized that AA race is an independent risk factor for PH and is associated with increased adjusted mortality. We extracted data for AA and Caucasian patients who underwent RHC at Vanderbilt between 1998 and 2014. Clinical information was obtained from Vanderbilt's Synthetic Derivative, a de-identified mirror of our Electronic Medical Record. A total of 4576 patients were analyzed, including 586 (13%) AAs and 3990 (87%) Caucasians. AAs were younger than Caucasians by an average of eight years, but had more prevalent heart failure, features of metabolic syndrome, and higher creatinine. AAs also had higher mean pulmonary artery pressure and pulmonary vascular resistance. After adjusting for relevant co-morbidities, the AA race is associated with 41% increased risk of PH (odds ratio [OR] = 1.41, 95% confidence interval [CI] = 1.12–1.79). Among patients with PH, AA race is associated with 24% increased adjusted mortality (hazard ratio [HR] = 1.24, 95% CI = 1.09–1.45). AAs were younger but had more prevalent cardiometabolic and renal disease and worse pulmonary hemodynamics. The AA race is an independent risk factor for PH. Among patients with PH, the AA race is associated with increased adjusted mortality. Future studies should focus on delineating whether genetic or environmental factors contribute to PH risk in AAs.

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“…However, these observations need to be validated 1) in health and disease, 2) longitudinally, and 3) in other populations. Racial, ethnic and socioeconomic differences need further exploration (28,36,37). Normal values for RV function are needed for physiological modifiers of the normal RV in pregnant subjects and athletes, and the effects of processes such as puberty, menopause, and aging merit study.…”

Section: American Thoracic Society Documentsmentioning

confidence: 99%

Assessment of Right Ventricular Function in the Research Setting: Knowledge Gaps and Pathways Forward. An Official American Thoracic Society Research Statement

Lahm

Douglas²,

Archer³

et al. 2018

Am J Respir Crit Care Med

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247

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Health Disparities in Patients with Pulmonary Arterial Hypertension: A Blueprint for Action. An Official American Thoracic Society Statement

Cited by 40 publications

References 130 publications

Impact of race on survival in pulmonary arterial hypertension: Results from the REVEAL registry

Impact of race on survival in pulmonary arterial hypertension: Results from the REVEAL registry

Racial differences in patients referred for right heart catheterization and risk of pulmonary hypertension

Assessment of Right Ventricular Function in the Research Setting: Knowledge Gaps and Pathways Forward. An Official American Thoracic Society Research Statement

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