Long-term health-related quality of life after surgery in patients with chronic thromboembolic pulmonary hypertension

Kamenskaya, O. V.; Клинкова, А. С.; Chernyavskiy, Aleksander; Ломиворотов, В. В.; Edemskiy, Alexander; Shmyrev, Vladimir

doi:10.1007/s11136-020-02471-z

Cited by 13 publications

(15 citation statements)

References 29 publications

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“…Residual pulmonary hypertension is associated with not only worsening survival but also worsened quality of life. Kamenskaya et al defined residual pulmonary hypertension as the factor that most affects quality of life after PTE (47). Additionally, those with residual pulmonary hypertension also had a greater incidence of hospitalization, persistent low functional capacity and death (48).…”

Section: Discussionmentioning

confidence: 99%

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Pulmonary thromboendarterectomy for chronic thromboembolic pulmonary hypertension: a systematic review

Brookes¹,

Li²,

Chung³

et al. 2022

Ann Cardiothorac Surg

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Background: Pulmonary thromboendarterectomy (PTE) is the gold standard treatment for patients with chronic thromboembolic pulmonary hypertension (CTEPH). However, the results are poorly quantified outside a few registry reports and several individual centers.Methods: A systematic review was performed searching five electronic databases assessing the outcomes for adult patients undergoing PTE for CTEPH. All articles that reported mortality data were included.Primary outcome measures were early/inpatient mortality; secondary outcomes were survival, pulmonary haemodynamics, morbidity and functional status following PTE for CTEPH. Results were pooled via a meta-analysis of proportions and meta-regression.Results: A total of 5,717 studies were identified, yielding sixty-one relevant papers. Thirty-day mortality ranged from 0.8% to 24.4%, and on meta-analysis was 8.4% [95% confidence interval (CI): 7.2-9.6%].Mortality was noted to decrease with increasing center volume of PTE cases (P<0.01). Residual pulmonary hypertension was reported in 8.2% to 44.5% of patients.Conclusions: CTEPH is associated with acceptable short-term mortality and an improvement in pulmonary hemodynamics. With increasing volume of experience and ongoing developments over time perioperative mortality continues to decrease.

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Section: Discussionmentioning

confidence: 99%

“…These heterogenous definitions make combining these reported rates unreliable. This systematic review notes that 8.2% to 44.5% (median 20%) of patients had residual pulmonary hypertension (47)(48)(49).…”

Section: Discussionmentioning

confidence: 99%

Pulmonary thromboendarterectomy for chronic thromboembolic pulmonary hypertension: a systematic review

Brookes¹,

Li²,

Chung³

et al. 2022

Ann Cardiothorac Surg

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“…For the BPA group, comparable pre-treatment utility values were available [ 24 ]. Post-treatment values were incorporated in the model for each particular group to best match potential changes in quality of life [ 5 , 23 – 25 ]. We assumed a stable utility for the no-treatment group equal to the pre-treatment value of the PEA group.…”

Section: Methodsmentioning

confidence: 99%

A model for estimating the health economic impact of earlier diagnosis of chronic thromboembolic pulmonary hypertension

et al. 2021

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BackgroundDiagnostic delay of chronic thromboembolic pulmonary hypertension (CTEPH) exceeds >1 year, contributing to higher mortality. Health-economic consequences of late CTEPH diagnosis are unknown. We aimed to develop a model for quantifying the impact of diagnosing CTEPH earlier on survival, quality-adjusted life years (QALYs) and healthcare costs.Material and methodsA Markov model was developed to estimate lifelong outcomes, depending on the degree of delay. Data on survival and quality of life were obtained from published literature. Hospital costs were assessed from patient records (n=498) at the Amsterdam UMC - VUmc, which is a Dutch CTEPH referral center. Medication costs were based on a mix of standard medication regimens.ResultsFor 63-year-old CTEPH patients with a 14 months diagnostic delay of CTEPH (median age and delay of patients in the European CTEPH Registry), lifelong healthcare costs were estimated at €117 100 for a mix of treatment options. In a hypothetical scenario of maximal reduction of current delay, improved survival was estimated at a gain of 3.01 life years and 2.04 QALYs. The associated cost increase was €44 654, of which 87% was due to prolonged medication use. This accounts for an incremental cost-utility ratio of €21 900/QALY.ConclusionOur constructed model based on the Dutch healthcare setting demonstrates a substantial health gain when CTEPH is diagnosed earlier. According to Dutch health-economic standards, additional costs remain below the deemed acceptable limit of €50 000/QALY for the particular disease burden. This model can be used for evaluating cost-effectiveness of diagnostic strategies aimed at reducing the diagnostic delay.

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“… 6 Due to limitation in daily activity and high financial cost, patients with CTEPH also suffered from profound emotional burdens and poor quality of life. 11 Increased BPA sessions and prolonged medical treatment could further increase patients’ anxiety. Therefore, earlier achievement of favorable hemodynamics is of prognostic and socioeconomic significance.…”

Section: Discussionmentioning

confidence: 99%

Predictors of early response to balloon pulmonary angioplasty in patients with inoperable chronic thromboembolic pulmonary hypertension

Zhang

Jin

et al. 2022

Ther Adv Respir Dis

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Background: To achieve favorable hemodynamics, the number of balloon pulmonary angioplasty (BPA) sessions varied significantly among patients with inoperable chronic thromboembolic pulmonary hypertension (CTEPH). Increased BPA sessions burdened patients financially and psychologically. We aim to identify baseline characteristics that could predict early BPA response. Methods: Consecutive patients who were diagnosed with inoperable CTEPH and received BPA between May 2018 and October 2021 at Fuwai Hospital were retrospectively collected. Patients were categorized into ‘Early BPA responders’ or ‘Non-early BPA responders’ according to the hemodynamic outcome within the first three BPA sessions. Results: In total, 101 patients were included into analysis. At baseline, non-early BPA responders had lower female proportion, longer disease duration, and poorer laboratory test results compared with early responders, whereas hemodynamics were comparable. After the first three BPA sessions, hemodynamic improvement was more significant in early responders. Incidence of complication was comparable between the two groups. Multivariable logistic analysis identified that female sex (odds ratio [OR]: 7.155, 95% confidence interval [CI]: 1.323-38.692, p = 0.022), disease duration (OR: 0.851, 95% CI: 0.727-0.995, p = 0.043), baseline total bilirubin (OR: 0.934, 95% CI: 0.875-0.996, p = 0.038), and baseline NT-proBNP (OR: 0.473, 95% CI: 0.255-0.879, p = 0.018) were independently associated with early BPA response. Combination of these four parameters could predict 90% early BPA response. Conclusions: Patients with shorter disease duration, female sex, lower baseline NT-proBNP, and lower baseline total bilirubin are more likely to achieve early hemodynamic response to BPA. Moreover, early hemodynamic response was not accompanied with increased incidence of procedure-related complications.

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Long-term health-related quality of life after surgery in patients with chronic thromboembolic pulmonary hypertension

Cited by 13 publications

References 29 publications

Pulmonary thromboendarterectomy for chronic thromboembolic pulmonary hypertension: a systematic review

Pulmonary thromboendarterectomy for chronic thromboembolic pulmonary hypertension: a systematic review

A model for estimating the health economic impact of earlier diagnosis of chronic thromboembolic pulmonary hypertension

Predictors of early response to balloon pulmonary angioplasty in patients with inoperable chronic thromboembolic pulmonary hypertension

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