Pulmonary Hypertension Surveillance

Abstract

Pulmonary hypertension (PH) is an uncommon but progressive condition, and much of what we know about it comes from specialized disease registries. With expanding research into the diagnosis and treatment of PH, it is important to provide updated surveillance on the impact of this disease on hospitalizations and mortality. This study, which builds on previous PH surveillance of mortality and hospitalization, analyzed mortality data from the National Vital Statistics System and data from the National Hospital Discharge Survey between 2001 and 2010. PH deaths were identified using International Classification of Diseases, Tenth Revision codes I27.0, I27.2, I27.8, or I27.9 as any contributing cause of death on the death certificate. Hospital discharges associated with PH were identified using International Classification of Diseases, Ninth Revision, Clinical Modification codes 416.0, 416.8, or 416.9 as one of up to seven listed medical diagnoses. The decline in death rates associated with PH among men from 1980 to 2005 has reversed and now shows a significant increasing trend. Similarly, the death rates for women with PH have continued to increase significantly during the past decade. PH-associated mortality rates for those aged 85 years and older have accelerated compared with rates for younger age groups. There have been significant declines in PH-associated mortality rates for those with pulmonary embolism and emphysema. Rates of hospitalization for PH have increased significantly for both men and women during the past decade; for those aged 85 years and older, hospitalization rates have nearly doubled. Continued surveillance helps us understand and address the evolving trends in hospitalization and mortality associated with PH and PH-associated conditions, especially regarding sex, age, and race/ethnicity disparities.

Alterations in Caveolin-1 Expression and Receptor-Operated Ca2+ Entry in the Aortas of Rats with Pulmonary Hypertension

“…Analyzing these Ca 2+ channels functions are important to further clarify the pathogenesis of PH. However, the development of PH is associated with a broad spectrum of diseases of different etiologies [40,[61][62][63]. The specific mechanism is not well understood, and two PH rat models were used instead of patients in our study.…”

Pulmonary Arterial Hypertension Treatment Guidelines

“…Th e articles by George et al 13 and Taichman et al 7 in this issue reveal the best of our accomplishments in PAH and the ongoing challenges that face patients with pulmonary hypertension and their providers. In PAH, advancing mechanistic insight, therapies directed specifi cally at the right ventricle, new trial designs and end points, and the hope of personalized medicine will shape future guidelines from CHEST and other organizations.…”

“…Key insight comes from an article by George et al, 13 also included in this issue of CHEST (see page 476 ). Th is study examined mortality data from the National Vital Statistics System and hospital discharge data from the National Hospital Discharge Survey.…”

“…Recent work has shown that PAH is a rare diagnosis in patients aged Ն 65 years, and other forms of pulmonary hypertension are much more common in patients who undergo a thorough evaluation for pulmonary hypertension cause. 14 Data from George et al 13 are, thus, best interpreted as showing that increasing mortality and hospital discharge data are largely driven by patients with pulmonary hypertension due to lung disease, left -sided heart failure, chronic thromboembolic pulmonary hypertension, or a mixture of these conditions. Th e work of George et al 13 shows that the bulk of pulmonary hypertension evaluated and treated by community providers is likely not addressed by the PAH-directed guidelines published in this issue.…”

Novel Targets of Drug Treatment for Pulmonary Hypertension

“…In 2010, women showed significantly higher mortality rates than men, and non-Hispanic blacks showed significantly higher mortality rates than non-Hispanic whites. Aged population cohorts (75)(76)(77)(78)(79)(80)(81)(82)(83)(84) and C85 years of age) show the highest PH mortality (47.9/100,000 and 108.7/100,000, respectively, 2010 data) [3]. Mechanisms for the development of PH are complex and may be idiopathic, genetic, or secondary to left heart disease, lung diseases, and/or chronic thromboembolism.…”