Volume Management in Pulmonary Arterial Hypertension Patients: An Expert Pulmonary Hypertension Clinician Perspective

Hameed²,

et al. 2020

Pulm. circ.

Readmissions for pulmonary hypertension are poorly understood and understudied. We sought to determine national estimates and risk factors for 30-day readmission after pulmonary hypertension-related hospitalizations. We utilized the Healthcare Cost and Utilization Project Nationwide Readmission Database, which has weighted estimates of roughly 35 million discharges in the US. Adult patients with primary International Classification of Disease, Ninth Revision, Clinical Modification diagnosis codes of 416.0 and 416.8 for primary and secondary pulmonary hypertension with an index admission between 2012 and 2014 and any readmission within 30 days of the index event were identified. Predictors of 30-day readmission were identified using multivariable logistic regression with adjustment for covariates. Results showed that the national estimate for Primary Pulmonary Hypertension vs Secondary Pulmonary Hypertension-related index events between 2012 and 2014 with 30-day readmission was 247 vs 2550 corresponding to a national readmission risk estimate of 17% vs 18.3%, respectively. The presence of fluid and electrolyte disorders, renal failure, and alcohol abuse were associated with increased risk of readmission in Primary Pulmonary Hypertension, while factors associated with Secondary Pulmonary Hypertension readmissions included anemia, congestive heart failure, lung disease, fluid and electrolyte disorders, renal failure, diabetes, and liver disease. The median cost of Primary Pulmonary Hypertension admissions and readmissions were $46,132 (IQR: $25,384–$85,647) and $41,604.50 (IQR: $22,481.50–$84,420.50), respectively. The median costs of Secondary Pulmonary Hypertension admissions and readmissions were $34,893 (IQR: $19,670–$66,143) and $36,279 (IQR: $19,059–$74,679), respectively. In conclusion, approximately 19% of Primary Pulmonary Hypertension and Secondary Pulmonary Hypertension hospitalizations result in 30-day readmission, with significant costs accrued during the index hospitalization and readmission. With evolving clinical terminology and diagnostic codes, future study will need to better clarify underlying factors associated with readmissions amongst pulmonary hypertension sub-types, and identify methods and procedures to minimize readmission risk.

Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

Risk factors for 30‐day readmission in adults hospitalized for pulmonary hypertension

Hameed²,

et al. 2020

Pulm. circ.

“…Diuretics are the main medication and effectively reduce right ventricular wall stress; however, diuretic-refractory cases require RRT. 6 Sztrymf et al reported that RRT is feasible for AKI complicated with RHF in PAH patients, although it is associated with a poor prognosis. Moreover, the introduction of RRT in unstable PAH patients may be hazardous due to complications such as hypotension.…”

Section: Discussionmentioning

confidence: 99%

Renal replacement therapy as a therapeutic option for right heart failure in severe pulmonary arterial hypertension

et al. 2022

Pulmonary arterial hypertension (PAH) is a progressively life-threatening disease that causes right heart failure (RHF). Renal dysfunction frequently complicates PAH with RHF and is associated with a worse prognosis. Renal replacement therapy (RRT) may be a therapeutic option, although its efficacy and safety are unclear. We describe a 30-year-old male with severe PAH who developed renal insufficiency and diuretic-refractory volume overload complicated with RHF but was successfully managed with intermittent RRT via a subcutaneously fixed superficial artery for 4 years. RRT led to haemodynamic stability, which enabled us to carefully de-titrate parenteral PAH drugs without worsening RHF. This case highlights that RRT may be a potential alternative for haemodynamic and volume control of refractory fluid retention complicated with RHF in severe PAH cases. Further studies are warranted to gain more insight into patient selection and the optimal timing of RRT in PAH patients with deteriorating RHF.

“…Regarding pharmacological treatment, diuretics are used in secondary pulmonary hypertension to reduce afterload 17 . This is supported by their use to lower pulmonary arterial pressure in patients with right heart failure 18 .…”

Section: Discussionmentioning

confidence: 99%

Development of Predictive Risk Models for All-cause Mortality in Pulmonary Hypertension using Machine Learning

Zhou

Wong

Lee³

et al. 2021

Preprint

BackgroundPulmonary hypertension, a progressive lung disorder with symptoms such as breathlessness and loss of exercise capacity, is highly debilitating and has a negative impact on the quality of life. In this study, we examined whether a multi-parametric approach using machine learning can improve mortality prediction.MethodsA population-based territory-wide cohort of pulmonary hypertension patients from January 1, 2000 to December 31, 2017 were retrospectively analyzed. Significant predictors of all-cause mortality were identified. Easy-to-use frailty indexes predicting primary and secondary pulmonary hypertension were derived and stratification performances of the derived scores were compared. A factorization machine model was used for the development of an accurate predictive risk model and the results were compared to multivariate logistic regression, support vector machine, random forests, and multilayer perceptron.ResultsThe cohorts consist of 2562 patients with either primary (n=1009) or secondary (n=1553) pulmonary hypertension. Multivariate Cox regression showed that age, prior cardiovascular, respiratory and kidney diseases, hypertension, number of emergency readmissions within 28 days of discharge were all predictors of all-cause mortality. Easy-to-use frailty scores were developed from Cox regression. A factorization machine model demonstrates superior risk prediction improvements for both primary (precision: 0.90, recall: 0.89, F1-score: 0.91, AUC: 0.91) and secondary pulmonary hypertension (precision: 0.87, recall: 0.86, F1-score: 0.89, AUC: 0.88) patients.ConclusionWe derived easy-to-use frailty scores predicting mortality in primary and secondary pulmonary hypertension. A machine learning model incorporating multi-modality clinical data significantly improves risk stratification performance.