Impact of the COVID-19 Pandemic on Pulmonary Hypertension Patients: Insights from the BNP-PL National Database

Abstract

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.

Impact of the COVID‐19 pandemic on care disruptions, outcomes, and costs in patients receiving pulmonary arterial hypertension‐specific therapy in the United States of America: An observational study

“…While the lockdown measures implemented in the period following the declaration of the COVID-19 pandemic in March 2020 impacted patients' ability to access healthcare services, they were likely to have also provided an important protective effect, as PH is a risk factor for worsened course of COVID-19 and elevated mortality. 7 The findings of our study quantifying the impact of care disruptions associated with the COVID-19 pandemic are supported by the results of a survey related to the care of patients with PH completed by 95 healthcare professionals in the US Pulmonary Vascular Disease NetWork, with responses collected from November 2020 to February 2021. 11 During the pandemic, 84% of physicians used telemedicine for PH patient care (vs. 15% before the pandemic).…”

“…Care disruptions in the immediate post‐COVID‐19 period were associated with more hospitalizations and higher inpatient costs among the group of patients who experienced a care disruption (individuals with no visits in the 6‐month immediate post‐COVID‐19 period, but who had at least one visit pre‐COVID‐19) versus those who did not experience a care disruption. While the lockdown measures implemented in the period following the declaration of the COVID‐19 pandemic in March 2020 impacted patients' ability to access healthcare services, they were likely to have also provided an important protective effect, as PH is a risk factor for worsened course of COVID‐19 and elevated mortality 7 …”

“…The data from our study raise concerns about the impact of care disruptions on patients treated for PAH. The pandemic had broader consequences for patients with emerging or new‐onset PAH, with a recent Polish study showing that new PAH diagnoses decreased, therapy escalations increased, and all‐cause mortality increased following the pandemic onset (from March to December 2020) 7 . A German study showed a close to 50% decline in new appointments for PH evaluation during the COVID‐19 lockdown (study period lasted from March 1, 2020 to April 30, 2020), with a similar reduction in initiation of PAH‐specific therapy, versus prior seasonally adjusted data 6 .…”

“…The SARS‐CoV‐2 (COVID‐19) pandemic was declared by the World Health Organization in March 2020. The lockdown measures introduced to control the spread of the infection posed unprecedented challenges in the management of patients with chronic diseases, including patients with PAH 6,7 . With limitations on the conduct of in‐person outpatient visits, healthcare professionals utilized telemedicine visits for patient consultations and evaluations 8 .…”

“…The lockdown measures introduced to control the spread of the infection posed unprecedented challenges in the management of patients with chronic diseases, including patients with PAH. 6 , 7 With limitations on the conduct of in‐person outpatient visits, healthcare professionals utilized telemedicine visits for patient consultations and evaluations. 8 However, the effectiveness of evaluating key components of PAH management, such as a patient's functional capacity and risk of progression, outside the in‐person healthcare setting is unknown.…”