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Clinical Classification and Prevalence of Pulmonary Hypertension in Rural Minnesota

L Mirfakhraie

Timothy Dirks

Stephanie Ebnet

Peter Eckman

Barry Cabuay

Ross Garberich

Shawna Reed

Peter Stockman

Eric Fenstad


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Conference: 2018 PHA International PH Conference & Scientific Sessions

Release Date: 06.28.2018

Presentation Type: Abstracts

File Download: Conference 2018_1020

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2018 International PH Conference and Scientific SeAbstract presented at the 2018 International PH Conference and Scientific Sessions in Orlando, Fla., June 28-July 1, 2018.

Background

Pulmonary hypertension (PH) is a progressive disease characterized by pulmonary vascular remodeling and subsequent right ventricular dysfunction. PH presentation and prevalence at major urban centers has been well described by national registries. PH identification and prevalence in rural communities has not been well described and may represent an opportunity for earlier patient diagnosis and treatment.

Methods

Retrospective review of all patients with estimated right ventricular systolic pressure (RVSP) > 50 mmHg by echocardiography or PH referral seen at three clinics in rural northern Minnesota between 8/1/2015 and 6/14/2017. Only patients with right heart catheterizations were included in analysis. PH classification was based on standard Nice Criteria. To determine prevalence, population data from Crow Wing County and Aitkin County, Minnesota was recorded from the 2010 Census. All patients were classified by zip code.

Results

Of 72 patients with RVSP > 50 mmHg, 21 patients had pulmonary arterial hypertension (PAH), 44 patients had PH due to left sided heart disease, 3 patients had PH due to chronic lung disease, 1 patient had chronic thromboembolic pulmonary hypertension, and 3 patients had exercised-induced PH. Of 21 patients with PAH, 1 patient had connective tissue disease, 1 patient had portopulmonary hypertension, and 1 patient had toxin-induced PH while 18 patients had idiopathic PAH. Prevalence of PH and PAH were calculated for Crow Wing County, MN and Aitkin County, MN using 2010 Census data and patient zip codes. Prevalence of PAH in Crow Wing and Aitkin Counties was 128 cases/million and 185 cases/million respectively.

Conclusions

PAH prevalence in rural Minnesota appears to be 2.5-12.5 times higher than the estimated 15-50 cases/million compared to national/international PAH registry data suggesting PH registries may not accurately reflect prevalence in rural communities. Review of echocardiogram outreach databases may provide an opportunity for earlier identification of PH patients.

Table 1: Right heart catheterization hemodynamics for Group 1 and Non Group 1 Pulmonary Hypertension