Conference: 2018 PHA International PH Conference & Scientific Sessions
Release Date: 06.28.2018
Presentation Type: Abstracts
File Download: Conference 2018_1030
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Abstract presented at the 2018 International PH Conference and Scientific Sessions in Orlando, Fla., June 28-July 1, 2018.
The primary objective of this analysis was to evaluate hospital readmissions after initiating PCY treatment in PAH patients.
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.
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.
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).
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.