Real-World Analysis of Treatment Patterns Among Hospitalized Patients with Pulmonary Arterial Hypertension

Abstract

Introduction: Hospitalization is an important clinical factor associated with survival and rehospitalization in patients with pulmonary arterial hypertension (PAH). Thus, this study examined treatment patterns before and after hospitalization in the US-specific population. Methods: Adult PAH patients in the United States were identified using the Optum Ò Clinformatics Ò database from January 1, 2014, to June 30, 2019, and were required to have continuous health plan enrollment for at least 6 months prior to the first (index) hospitalization through at least 90 days post-discharge. Baseline patient characteristics were evaluated from 6 months prior to through the index hospitalization. PAH treatment patterns were examined from 30 days pre-index admission (pre-hospitalization) and 90 days post-index hospital discharge (post-hospitalization), and stratified by therapy type: monotherapy,

Prescription patterns of ambrisentan in some cities of Colombia

“…The median age of the patients in this study was similar to that found in some studies in Asia (47.0–50.8 years) 20 , 21 and Europe (49.6–52.0 years), 22 , 23 , 24 but in other reports from Europe (61.0–61.6 years), 13 , 14 , 25 North America (62.7–68.1 years) 17 , 26 , 27 , 28 and Oceania (60.0 years), 29 patients were older, 13 , 14 , 17 , 25 , 26 , 27 , 28 , 29 and there was a predominance of women (82.1% vs. 61.0–79.0%). 13 , 14 , 15 , 17 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 Arterial hypertension was the most prevalent comorbidity in this report, which is consistent with the literature. 17 , 20 , 26 , 27 , 28 , 29 , 30 , 31 Pulmonary arterial hypertension (Group 1) was the most prevalent, in line with other studies with real‐world evidence, 20 , 22 , 23 , 25 and most of the patients had WHO Functional Class I; this diffe...…”

Predicting Risk of 1-Year Hospitalization Among Patients with Pulmonary Arterial Hypertension

“…Since combination therapy is costly [23], it is important for healthcare providers and payers to have practical and easy-to-use risk assessment tools to predict the need for possible treatment interventions among patients with PAH. Alongside those of other recent real-world studies [21,22,24], the findings of the current study regarding the high proportions of patients with PAH who experienced hospitalization within 1 year following initiation of at least one PAH indicated medication, with 96% treated with monotherapy from 2009 through 2019, suggest that there remain significant barriers to utilization of combination therapy even among high-risk patients. In a study that examined the transition of care of patients with PAH from hospitalization to the outpatient setting and its improvement describe prior authorization requirements, PAH medication complexity, required enrollment into risk evaluation programs, and specialty pharmacy dispensing as barriers to receiving treatment with PAH indicated medications [25].…”

“…On the basis of such favorable clinical trial evidence for combination therapy, it is recommended in the ESC/ERS PH treatment guidelines initially for treatment-naı ¨ve newly diagnosed patients with PAH and those who are already treated [13,20]. Despite the evidence-based 2015 treatment recommendations, the utilization of combination therapy among patients with PAH in the USA has had a slow uptake [21], reaching a reported maximum of approximately 20% in an observational study of 3116 patients with PAH selected from a US administrative commercial claims database between January 2014 and June 2019 [22]. Furthermore, in this study by Ogbomo et al [22] of hospitalized patients with PAH, 65% were treated with monotherapy prior to hospitalization and less than 7% had treatment escalation following an all-cause hospitalization.…”

“…Despite the evidence-based 2015 treatment recommendations, the utilization of combination therapy among patients with PAH in the USA has had a slow uptake [21], reaching a reported maximum of approximately 20% in an observational study of 3116 patients with PAH selected from a US administrative commercial claims database between January 2014 and June 2019 [22]. Furthermore, in this study by Ogbomo et al [22] of hospitalized patients with PAH, 65% were treated with monotherapy prior to hospitalization and less than 7% had treatment escalation following an all-cause hospitalization. These study findings indicate that in the USA, routine treatment practices of patients with PAH do not involve treatment escalation with combination therapy to a great extent even following a hospitalization event.…”

The nitric oxide–soluble guanylate cyclase–cGMP pathway in pulmonary hypertension: from PDE5 to soluble guanylate cyclase

“…In recent studies, 47−58% of patients with PAH were reported to be receiving PDE5i, whereas only 6% were receiving riociguat [ 127 , 128 ].…”