Calendar | For Your Patients | PHA Main Site | Contact Us | About Us | Not a registered user? Sign up here.

Resource Library

Treatment With Prostacyclins Reduces Hospital Readmissions Among Patients with Pulmonary Arterial Hypertension

C Blanchette

J Noone

R Howden

P Classi

K Gordon

A. C. Nelsen

Reviews

  Sign in to add a review

0 comments
Leave a Comment

Conference: 2018 PHA International PH Conference & Scientific Sessions

Release Date: 06.28.2018

Presentation Type: Abstracts

File Download: Conference 2018_1030

Download Adobe Acrobat

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.

Purpose

The primary objective of this analysis was to evaluate hospital readmissions after initiating PCY treatment in PAH patients.

Background

Pulmonary arterial hypertension (PAH) is characterized by high-blood pressure in the pulmonary vasculature and is a chronic, life-threatening disease. Commonly used PAH treatments include endothelin receptor antagonists, phosphodiesterase inhibitors, and prostacyclins (PCYs). PCYs while often considered gold-standard therapy, are commonly reserved for later stage disease.

Methods

We employed a retrospective analysis using the U.S. Pharmetrics Database from 2011-2015 in patients with PAH, defined as >2 ICD-9-CM codes for pulmonary hypertension (416.0X or 416.8X) and evidence of right heart catheterization. Inclusion criteria required a hospitalization for PAH or a PAH-related condition with no history of PCY use. Outcomes between two cohorts were compared: 1) PAH patients discharged from hospital with PCY therapy (PCY group) vs. 2) PAH patients discharged from hospital with any combination of therapies except PCY therapy (alternative medical care [AMC] group). T-tests and ANOVAs were used to compare continuous variables and Chi-square tests were used to compare categorical variables. Cox proportional hazard model was used to generate hazard ratios for hospital readmission risk.

Results

The PCY group (n=110) was younger (mean age[SD] = 49.74[16.35] vs. 54.61[16.83]), had a higher proportion of females (64.55% vs. 46.56%) and a lower average Charlson Comorbidity Index (CCI) score (3.89[2.26] vs. 4.86[2.81]) compared to the AMC group (n=4270) (p<0.01). Treatment within the PCY group consisted of treprostinil (67.27%), epoprostenol (26.36%) or iloprost (6.36%). During the study period, 40.91% of the PCY group were readmitted to the hospital for PAH or a PAH-related condition compared to 52.18% for the AMC group (p=0.02). Mean time to hospital readmission was 397 days for the PCY group vs. 219 days for the AMC group (p<0.01). The rate of 30-day hospital readmissions for all-causes was 5.45% for the PCY group compared to 23.44% for the AMC group (p<0.01). After adjusting for age, gender and CCI, the hazard ratio for PAH and PAH-related hospital readmission risk was 0.64 for the PCY group (p<0.01, AMC group as reference cohort).

Conclusions

PCY treatment is associated with a lower risk of hospital readmission, potentially warranting earlier use of these medicines. Additional studies need to be conducted to validate this finding.