Impact of comorbidities and delay in diagnosis in elderly patients with pulmonary hypertension

Abstract

Patient age at diagnosis of pulmonary hypertension is steadily increasing. The present study sought to analyse clinical characteristics, time to diagnosis and prognosis of pulmonary hypertension in elderly and very elderly patients.A study was conducted in a French regional referral centre for pulmonary hypertension. All consecutive patients diagnosed with pre-capillary pulmonary hypertension were included and categorised according to age: <65 years (“young”), 65–74 years (“elderly”) and ≥75 years (“very elderly”).Over a 4-year period, 248 patients were included: 101 (40.7%) were young, 82 (33.1%) were elderly and 65 (26.2%) were very elderly. The median age at diagnosis among the total population was 68 years. Compared with young patients, elderly and very elderly patients had a longer time to diagnosis (7±48, 9±21 and 16±32 months, respectively; p<0.001). Patients ≥75 years also more often had group 4 pulmonary hypertension. The median overall survival was 46±1.4 months, but was only 37±4.9 months in elderly patients and 28±4.7 months in very elderly patients. Survival from the first symptoms and survival adjusted to comorbidity was similar across age groups.Patient age should be taken into account when diagnosing pulmonary hypertension as it is associated with a specific clinical profile and a worse prognosis. The difference in prognosis is likely to be related to a delay in diagnosis and a greater number of comorbidities.

Comparative outcomes in patients receiving pirfenidone or nintedanib for idiopathic pulmonary fibrosis

“…Moreover, the off-label prescription of antifibrotic drugs is expected to be very rare. Indeed, in the large international PASSPORT registry, only three of 1009 patients enrolled (and none for the subgroup from France) had a diagnosis other than IPF, despite the fact that this registry allowed the inclusion of subjects with other indications [ 26 ]. Therefore, although the diagnosis was not confirmed individually for each patient, we are confident that prescription of antifibrotic medications was limited to patients with IPF.…”

Pulmonary hypertension: Pathophysiology beyond the lung

“…Ginoux et al recently published a study conducted in France that evaluated 248 patients in groups 3 or 4 of pulmonary hypertension. The median survival was only 46 months and the prognosis was even worse in the elderly (≥65 years) and very elderly patients (≥75 years) being 37 months and 28 months, respectively (38). Despite great efforts to introduce new therapies, some patients are refractory to multidrug therapy and lung transplantation is the only available option (36).…”

Implementation of a systematic comprehensive geriatric assessment for elderly patients suspected of pulmonary hypertension

“…However, in another French monocenter cohort, nearly a quarter of patients with 75 years and more had a CTEPH (27). The increasing risk of pulmonary embolism with age (28) may explain these results.…”