Mortality in US veterans with pulmonary hypertension: a retrospective analysis of survival by subtype and baseline factors

Abstract

Pulmonary hypertension (PH) occurs when the pulmonary vasculature is itself diseased or becomes affected secondarily by comorbid conditions, commonly left heart or lung disease. The high prevalence of chronic cardiopulmonary conditions among patients served by Veterans Health Administration (VHA) suggests this population may be particularly susceptible to PH. We sought to identify clinical features and outcomes in veterans diagnosed with PH. We utilized the VHA Corporate Data Warehouse to identify veterans diagnosed between January 1, 2003 and September 30, 2015, assess relevant patient characteristics and their survival time. The effects of PH subtype and baseline factors on outcome were estimated by Cox modeling. There were 110,564 veterans diagnosed with PH during the study period. These veterans were predominantly male, had median age 70.2, and had a high burden of comorbid conditions. PH was frequently due to left heart and/or lung disease. Average survival after PH diagnosis was 3.88 years. Compared with other types, PH due to left heart disease, lung disease or both had shorter survival. This large retrospective study of veterans demonstrates the significance of PH due to left heart and/or lung disease which was common and had high risk of death. Multi-comorbidity was common and added to risk. These findings underscore the need for risk assessment tools for subjects with non-Group 1 PH and novel management strategies to improve their outcome. This study details the largest retrospective cohort assembled for evaluation of secondary PH and allows hypothesis-generating inquiries into these common conditions that are rarely prospectively studied.

The Role of Regulatory T Cells in Pulmonary Arterial Hypertension

“…PAH is a lethal cardiopulmonary condition characterized by pulmonary vascular remodeling and right heart failure ( 10 ). Drugs used to treat this disease primarily target pathologic vasoconstriction, but there is an additional rationale for treating immune dysregulation ( 9 ).…”

Repetitive but not single blast mild traumatic brain injury increases ethanol responsivity in mice and risky drinking behavior in combat Veterans

“…Traumatic brain injury (TBI) affects every segment of the population and can be comorbid with post-traumatic stress disorder (PTSD), leading to significantly decreased quality of life and social and occupational functioning. This is particularly important for Veterans, who experience disproportionate rates of physical and mental illness compared to civilian counterparts [1-3]. Critically, US Veterans of the conflicts in Iraq and Afghanistan (Operation Enduring Freedom/Operation Iraqi Freedom/Operation New Dawn (OEF/OIF/OND)) exhibit especially high rates of mild traumatic brain injury (mTBI; labeled the “signature injury” of these conflicts) that is highly comorbid with PTSD [4-7].…”

Riociguat treatment in patients with chronic thromboembolic pulmonary hypertension: Final safety data from the EXPERT registry

“…The estimated survival rate in patients with CTEPH in EXPERT (94.7%, 85.7%, and 79.3% at 1, 2, and 3 years, respectively) appears to be higher than in non-operable patients in the international CTEPH registry (88%, 79%, and 70% at 1, 2, and 3 years, respectively) [22], non-PEA patients in the Giessen registry (84.5% at 1 year and 72.5% at 3 years) [24], US veterans evaluated in a retrospective analysis (89.2%, 81.4%, and 72.7% at 1, 3, and 5 years, respectively) [25], and patients in several other registries [12,13,24,[26][27][28]. Riociguat is approved for treatment of chronic thromboembolic pulmonary hypertension (CTEPH).…”