PCV22 Treatment Patterns and Outcomes in Patients with Pulmonary Arterial Hypertension and Chronic Thromboembolic Pulmonary Hypertension: Results of a Retrospective Chart Review in Six European Countries

Abstract

OBJECTIVES: This study examined VTE prophylaxis and VTE risk reduction and readmission in a cohort of hospitalized medically ill patients in the real-world clinical setting during hospitalization and post discharge. METHODS: This 5-year retrospective study used linked outpatient files from MarketScan ® Commercial and Medicare Supplemental databases, thereby providing continuity of therapy through hospitalization and post-discharge. Patients were categorized into prophylaxis and non-prophylaxis groups based on use of any guideline-recommended anticoagulants from the index date to 180 days after index hospital discharge, and before the date of the first VTE event. Outcome variables were VTE events and re-hospitalization. Risk adjustment was conducted within the prophylaxis group, and between the prophylaxis and non-prophylaxis groups using propensity score matching. RESULTS: Among 3916 patients identified, 29.37% (nϭ1295) were admitted with cancer, 18.25% (nϭ805) with pneumonia, 14.24% (nϭ628) with heart failure, 11.25% (nϭ496) with sepsis, 8.19% (nϭ361) with infectious diseases, 5.67% (nϭ250) with severe respiratory disorders, and 1.84% (nϭ81) with inflammatory bowel disease (IBD). Among these patients, only 1819 (51.81%) received anticoagulant therapy and 242 (6.18%) received non-pharmacological prophylaxis only during their hospitalization and until 180 days after discharge. The anticoagulant therapy rates ranged from 88.64% in obesity to 32.39% in IBD patients. Among patients who received anticoagulant therapy, 740 (40.68%) received low molecular weight heparin only and 806 (44.31%) received unfractionated heparin. After risk adjustment, compared to patients without VTE prophylaxis, those patients who received anticoagulant prophylaxis had lower VTE rates (3.62% vs. 4.27%., pϽ0.04) and lower readmission rates (24.22% vs 27.95%, pϽ0.02) during the 6-month period from the index hospital admission. CONCLUSIONS: Despite existing guidelines, anticoagulant prophylaxis is underutilized in medically ill patients in clinical practice. Anticoagulant prophylaxis is associated with reduced risk of VTE and rehospitalization in medically ill patients.