2023 PH Professional Network (PHPN) Symposium: Abstracts

M. El LabbanMayo Clinic Health System, Mankato, Minnesota, MNS. KhanMayo Clinic Health System, Mankato, Minnesota, MNI. Bou AkiMayo Clinic Health System, Mankato, Minnesota, MNH. GuleidMayo Clinic Health System, Mankato, Minnesota, MNCategory: Clinical ScienceSubcategory: Diseases and Conditions Associated with PHBackground: Acute myocardial infarction (AMI) is one of the leading causes of morbidity and mortality. Pulmonary hypertension (PH) is often missed as a diagnosed comorbidity in patients admitted with AMI. We aimed to study the effect of PH (all categories) on the outcomes of patients admitted with AMI with further subclassifications into ST elevation myocardial infarction (STEMI) and non-STEMI.Methods: Using the National Inpatient Sample Database from 2017 to 2020, a retrospective study of adult patients with principal diagnosis of AMI with secondary diagnosis with or without PH according to ICD-10 codes. Several demographics, including age, race, and gender, were analyzed. The primary endpoint was mortality, while the secondary endpoints included mechanical intubation, length of stay in days, and patient charge in dollars. Multivariate logistic regression model analysis was used to adjust for confounders, with a P value <0.05 considered statically significant.Results: The study included 1 830 229 patients admitted with an AMI, of which 37 895 of which had PH. The mean age for patients with and without PH was 72.8 and 66.7 years, respectively. In the PH group, 50% were females compared with 37% in the non-PH group. Around 70% in both groups were White. Statistically significant comorbidities noticed in the PH group included sepsis (4% versus 2%), diabetes mellitus (47% versus 40%), hypertension (89% versus 81%), acute kidney injury (36% versus 19%; P < 0.01). In-hospital mortality rate was higher in the PH group with statistical significance (7.2% versus 4.6%, P < 0.01). The adjusted odds ratio (aOR) was 0.99 without statistical significance. In the STEMI group, mortality rate was higher in the PH group with statistical significance (15.7% versus 7.8%, P < 0.01) similar to the non-STEMI group (5.9% versus 3.3%, P < 0.01). The odds ratio if in-hospital mechanical ventilation was only statistically significant in the STEMI group (aOR = 1.32, P = 0.01). The length of stay was longer in the PH group across the 3 groups (AMI: 6.5 versus 4.35 days, aOR = 0.87, P < 0.01; STEMI 6.6 versus 3.9, aOR = 0.87, P < 0.01; non-STEMI 6.5 versus 4.5 days, aOR = 0.88, P < 0.01). Patients in the PH group had a higher total charge in the 3 groups (Figures 1 and 2).Conclusion: Patients admitted with AMI with associated PH were found to have worse clinical outcomes and a higher economic burden. Practicing clinicians should be aware of the significance of associated PH as a comorbidity in the setting of AMI.L. MielniczukUniversity of Ottawa, ON, CanadaS. ProvencherUniversité Laval, QC, CanadaJ. SwistonUniversity of British Columbia, BC, CanadaJ. WeatheraldUniversity of Alberta, AB, CanadaC. ZhangJanssen Business Technology Commercial Data Sciences, NJS. GoldenIQVIA Solutions Canada Inc., ON, CanadaBrad MillsonIQVIA Solutions Canada Inc., ON, CanadaCategory: Clinical ScienceSubcategory: Therapeutic StrategiesBackground: Pulmonary arterial hypertension (PAH) is a serious, progressive disease that usually leads to right heart ventricular failure and death. Although treatment guidelines include recommendations for combination drug therapy with selexipag (prostacyclin receptor agonist), research examining real-world persistence and potential predictors of persistency in the Canadian population is sparse.Methods: This retrospective claims database analysis included PAH patients (inferred) with ≥1 selexipag claim from Ontario Drug Benefits (ODB), Régie de l’assurance maladie du Québec (RAMQ), or Canadian Private Drug Plan (PDP) databases between April 2016 and July 2021. Selexipag persistence was calculated from index date (first selexipag claim) until discontinuation (no further selexipag claims) or censoring (no further claims in any database or persistent at the end of the study period). Persistence was estimated by Kaplan-Meier (KM) analyses. Four feature selection models (stepwise Cox proportional hazards, Boruta, Coxnet, and Random Survival Forest) were used to rank 28 potential predictors of persistence, including clinical and demographic variables. The top 12 (average model rank) were included in a Cox proportional hazards model for selexipag persistence.Results: Of 311 patients identified throughout the observation period (PDP = 101, 32%; ODB = 181, 58%; and RAMQ = 29, 9%), 70% were female and 71% were aged 50–79 years. During the study period, 129 patients (41%) discontinued selexipag, including 16 (5%) who switched to intravenous prostacyclin. Another 69 patients (22%) were censored, and 113 (36%) were persistent on selexipag at the end of the study. From the KM analysis, 62% of patients were persistent on selexipag after 1 year, 48% after 2 years, and 33% after 4 years (Figure 1). None of the predictors tested reached statistical significance level (0.05). However, 3 predictors had P values <0.1: baseline use of double oral combination therapy (heart rate [HR] = 0.63; 95% confidence interval [CI] = 0.38, 1.04), sildenafil monotherapy (HR = 1.92; 95% CI = 0.97, 3.58), and riociguat monotherapy (HR = 2.31; 95% CI = 0.89, 5.23).Conclusion: This is the first Canadian retrospective claim database study to examine the persistence and predictors of persistency of PAH patients on selexipag. Persistence on selexipag in this cohort was 62% at 1 year and 33% at 4 years. However, none of the predictors of selexipag persistence tested in this study reached significance in this ­population. Further research into predictors of selexipag persistence is needed to help improve potential treatment outcomes and therefore benefits for PAH patients.K. LoiCommunity Medical Centers, Fresno, CaliforniaCategory: Clinical ScienceSubcategory: Therapeutic StrategiesBackground: Prostacyclins are high-risk, high-alert medications that have been shown to actually or potentially cause significant harm to the patient, even when used as intended. As a result, inpatients receiving prostacyclins require care from specially trained nurses and pharmacists. With the recent newer prostacyclin dosage formulations coming to market, in this study, we seek to provide baseline data on inpatients who receive prostacyclins at our Pulmonary Hypertension Center of Comprehensive Care.Methods: Hospital encounters with inpatient medication orders for prostacyclins between January 1 and December 31, 2022, were identified by electronic health record. Prostacyclin route of administration, average length of stay, and average discharge dose were extracted from the electronic health record patient encounter.Results: This study included 62 hospital encounters by Of 62 hospital (22%) and oral prostacyclin. patients of the 62 hospital encounters the Four of 62 encounters were for and 4 were on prostacyclin. The mean discharge dose was and mean length of stay was for patients on prostacyclin. The mean discharge dose was and mean length of stay was for patients on prostacyclin (Figures a period, patients on prostacyclin therapy to the hospital 62 patients of the 62 hospital encounters the The mean length of stay for patients on prostacyclin therapy is between and research be the in length of stay and of care between patients receiving and oral prostacyclin Diseases and Conditions Associated with PHBackground: is a and disease with for is associated with including disease and arterial hypertension The treatment for this of PAH is the of clinical and treatment is by the diagnosis of treatment for and the outcomes for 3 patients with clinical was on 3 patients to the Pulmonary Hypertension at Hospital in patients had and were receiving treatment or have included patients were to have PAH by right heart or to have hypertension (PH) by data by the which is with PAH in 3 patients had the patient was diagnosed at age and our female age of diagnosis was average 28 years female patients were on therapy for a mean of years to the diagnosis of PH. patients had the estimated of mean of when was data = mean of of index of of Pulmonary in in the first 33% of and after for for for was of and adjusted was 70% of patients had to PH treatment and had including for a mean of years to diagnosis of treatment patients had for both treatment and PH 2 of our patients intravenous therapy for and 1 patient was with and 2 with of and when patient had to in to and disease to patient with PAH was with 4 and 1 patient was on and a of and leading to the of clinical and the of which is with the data to research is needed into the of and is needed to the mean to Patients with should have with if the clinical a of We a of to in to or a combination of treatment be from our to have a of leading to our that care should be to the which are the Inc., Clinical ScienceSubcategory: Diseases and Conditions Associated with PHBackground: is a as an combination in the treatment of patients with arterial hypertension (PAH) or hypertension associated with disease is of which and dose to a In a a and that is a the In the 1 study, a and as compared with and is to the at as as of was found to be and was in This study to the and and of of in with PAH or study was to patients with PAH or be into 2 with with PAH or on a dose who are to to and with PAH who are receiving a prostacyclin at the of study in in a study and to 12 in in a study and to 12 In a of in a to after of and The include and clinical and the PH and In this study, we the of as compared with of and treatment with in patients with PAH or The of this study is We that similar and in patients with PAH or of Clinical ScienceSubcategory: Diseases and Conditions Associated with PHBackground: is to care for patients with hypertension the of a were to inpatient and PH was into the medication and effect was This is a retrospective cohort analysis for the period to July encounters were to PH disease were included of patients with of of and medication effect medication to and patients encounters were 2 patients the study period, a ratio of to In of patients had a of medication of 28 patients reached an level of effect of patients with reached and of 28 patients reached (Figures The of a PH to of medication and in are have been at a of of of of of of of of Clinical ScienceSubcategory: of The level for patient is at a been shown that patient for drug that is of a higher Patients with health to be or even the leading to patient for drug the were included in this Four of the patient the of and Data are by the research group to and were used for the of data the level of patient the to be between the and on the research group that patient for arterial hypertension drug be to to level and improve and be and at the Pulmonary Hypertension of ScienceSubcategory: and clinical and are to and to in of an or the of patient However, to improve patient in clinical in The of clinical is in the of clinical improve of care and are in the and of for the who be that patients of or have in in if by a are on a if at Pulmonary arterial hypertension (PAH) is a disease by an elevation of and leading to right ventricular failure and death. PAH is as a with an estimated patients are even in that data are to the of patients for and in years, which to potentially and the of the data to of identified that PAH patients be to in clinical are by and a of with patients and are in a to the of and However, often the and to to have of confidence or of clinical and for patients nurses and from clinical and as an for a missed for with a and the clinical and the of with PAH patients and help improve the of of in clinical to who to the Pulmonary Hypertension Pulmonary Hypertension be to in a and be or and be for patients with The is an from the study, which been for use with nurses and been for the of this be date is be date is of at of at of at of at Clinical ScienceSubcategory: of Patients with hypertension (PH) in patients and of leading to treatment and clinical that health in PH. However, to be and to an of the for PH potentially improve and of patients and is was included 12 patients with PH who an in a to December The included including to the PH and and for the 3 1 and and the The were to December were with the and and the and were We the for of that were females aged and years with PH. as the 1). included in of into of to and of a is to are to and to to have to that in a the noticed if and to was in the and noticed have for one the on the is even to a the a as when a compared to to and for with PH. Patients in and with of into PH Medical of Medical Medical of of of of of of of Fresno, Fresno, Clinical ScienceSubcategory: Diseases and Conditions Associated with PHBackground: disease and in arterial hypertension be Data from clinical and real-world that patients a mean oral dose by 16 while on reached higher at the an study, the of to higher of oral in patients with was to oral which was The primary endpoint was of a oral dose at endpoints included in clinical from baseline to was as to were included in analyses. Patients had to have a with Health or and be on or 2 PAH the mean oral dose was with of the primary in of < and From to from to with a of = from to with a of = right from to with a of = Statistically significant were in = and the of = were in PAH and treatment for the dose oral in de were in clinical and as a to of oral by Clinical ScienceSubcategory: Therapeutic StrategiesBackground: Pulmonary hypertension (PH) is a disease As the and patients require treatment in health of and be for patient to in year 2020, our health had patients with a diagnosis of PH who were for a of The of a PH at our in with a to hospital PH group was that included an heart failure as and care clinical and both inpatient and This group throughout the and was with including inpatient and the heart and hospital across the health were aware of to care for this patient The was trained on to PH including the and and medication for inpatient and and were for therapy was to the hospital in 2021. In December a was for of to patients with PH. prostacyclin therapy and was for prostacyclin therapy in December As of this a was into the electronic record to patient In January a PH was for of care between heart failure and is for and for this include of a of a medication of a PH the electronic and for Pulmonary Hypertension As the of PH in to as a patients be and health This for PH be used to in to Hypertension Hypertension Hypertension Hypertension Inc., of and on PH The to to hypertension (PH) including and We an research and to an study of PH patients that and to for use in in patient In this study, we aimed to of and to care use and medication PH We a to to Pulmonary Hypertension of = patients and = The included care use the 3 and care use the 3 We an and to 2 the to in the study, in = We were to care use to in the data for of statistically significant in PH care including to an to in care care and care The the had a health care treatment to receive and as in the 3 The for who were to a in the 3 was that were or had The that of had care for PH in the 3 and were to use in the 3 We further the analysis into of care use as and and the of medications health care had and The of medications was to be a of care use of who were had medications versus of who were only of who were had medications versus 50% of who had the (Figures The a on PH patient care and PH patients to to The of the study to that patients are the or the care health care medication were with and care The health care is to to with the in care from the PH and PH patients care to as and of and on care to be needed to the of care for Clinical ScienceSubcategory: Diseases and Conditions Associated with PHBackground: that the of hypertension and disease is for of is a of after acute In this leads to a missed to a disease or disease that have to the In our PH care a of and in to our arterial hypertension Health 1 patient We for patients who had persistent an acute years of the disease and improve our in we an acute with the of our inpatient in July we a for for acute patients an and noticed patient to the included of an patient and and to patients We with our inpatient to a that for patient to the The of our included an for of an the and with our care to with As a result, we a significant in patient to the and were to patients with and years. outcomes included of and diagnosis of disease that to the with medication and to a treatment or and receiving from health care as we identified including care for patients who our for a ventilation on and We have a in for acute patient and have with the to patients who be identified our this our PH to a for this patient of of of of Medical Medical Medical Clinical ScienceSubcategory: patients with are at for of hypertension a clinical and demographic associated with primary care and in as with cohort study from the 2016 Inpatient Database and were and of were estimated and compared between patients with and without PH the or rank analysis was by a logistic regression model to associated with PH the cohort odds and 95% confidence PH was the primary and was identified ICD-10 in the total of were The mean age was and were The of PH was were 37 patients with and the of PH this cohort was associated with PH included disease of = 95% CI = heart disease = 95% CI = = 95% CI = = 95% CI = = 95% CI = = 95% CI = hypertension = 95% CI = disease = 95% CI = = 95% CI = or = 95% CI = = 95% CI = = 95% CI = in health = 95% CI = patient age = 95% CI = hospital in the = 95% CI = and was = 95% CI = 0.89, The of PH patients with was 3.3%, which is the of PH in the 2016 Several were associated with PH. that the only are needed to further the between clinical and demographic as and potential for of Health Medical Health Medical Health Medical Health Medical Health Medical Health Medical Clinical ScienceSubcategory: Pulmonary hypertension (PH) associated with is a of associated with mortality. However, the clinical and of with that of a level of to be to to the clinical is to for at in with help We have identified a of in in The of the study is to the value of in in We from of the first of The were at until The were extracted and was from total the data the Of the only 16 were in the in our regression was calculated for the 16 and to the Of the of were diagnosed with at of on and of with National of Health and regression of the 16 who on to versus at of the = with and of and (Figure of in with of of 16 in significant value in that are at for at This in a cohort the potential as a clinical to for disease and as needed with and and to for Medical Clinical ScienceSubcategory: and Pulmonary hypertension (PH) is a progressive disease and is associated with mortality of the the PH mortality rate from to However, in mortality and have been We data from the for and Data for of Database for in the from to We identified ICD-10 codes. We the cohort into and regression was used to mortality rate and to from to were between and Of of were from from and from The mortality from PH 1 population were in in and in From to in in and in The in 1 population from to between and to and between and to and was an in However, the between and The are to demographic and a combination of and to health Further on the causes for are needed to the and the of from PH. As an of we be demographic age and in mortality between of Medical MNCategory: Clinical ScienceSubcategory: of The Health arterial hypertension (PAH) and are used to of patient health as treatment and disease burden. In this study, we aimed to the between and in patients with In this study, we data for with PAH on oral in the were for at for and Health was by or patients the Pulmonary Hypertension of have shown between and of were or were used to of patients for this Patients had a mean age of were and were patients were and 4 of mean with higher from to to and were = P < 0.01). with higher mean were similar across and was with = P < was with = P = with and are of patient health that as patient health be in care for patients with arterial Diseases and Conditions Associated with PHBackground: The study to be is on hypertension This a patient our is and which to treatment of the disease We and 1 to be The patient with The for this study to be in of of of of Clinical ScienceSubcategory: Therapeutic StrategiesBackground: The of Medical a Pulmonary Hypertension Center of Comprehensive medication to the medication use of prostacyclins and arterial hypertension in the inpatient guidelines include a that between to or from a prostacyclin are an inpatient Prostacyclin are only in Medical is the for medication with the Medical as an on or of nurses in and and to disease and of PAH and use as a for patient to the medications included in the a and a The for medication include are of intravenous as for to oral dose and The as between medication is of recommendations for intravenous as and care as of medication from to Selexipag been for inpatient We inpatient including and from a data of the electronic record. Patients were included if a between selexipag and or to or patient was included if or medication from to selexipag, from selexipag to From July 2016 to December of 2022, patients were between selexipag and a prostacyclin. was The were = and = and The 12 = and the was a of = of the patients from a prostacyclin to selexipag. Of 16 from and 16 to patients from selexipag to a = to and = to patients were from the 3 patients the hospital stay after the Of the patients who were = were with selexipag, and = were with prostacyclin with and with is to inpatient between oral and prostacyclin medications in patients with patients with arterial hypertension (PAH) are with the prostacyclin in or oral or the prostacyclin receptor selexipag. Patients who between medications often recommendations for and that in the hospital or as an However, hospital are and are for patients and had with we that prostacyclin in PAH patients be and patients with PAH between prostacyclins with medication in the at and in for selexipag were estimated from and patients as and on dose for at 1 In selexipag was at after 1 for In prostacyclin in patients with PAH is for and the use of hospital Inc., of The of patients and patient are in health including drug patient was to into with arterial hypertension (PAH) and to clinical research and disease and patient patient was with patients 2 with a of including 1 in 3 in and 2 in included PAH and The included a and a of with The patients with which are into of and of are primary This to of Patients with with diagnosed after while were for years. that were to or on and health are the and this is by the from and that disease is an Health outcomes from treatment patients to have to in Patients to for as as treatment be and on and Patients that oral medications help with Patients are in clinical are are for on and drug patients disease be and (Figure This a for for the and patient into clinical to help the of treatment Therapeutic StrategiesBackground: been used for in disease and been for from to is to with which the medication to the is the dosage and the for We by 2 patients from the Pulmonary Hypertension Center who while on and used for patients had to the were was as an The 2 patients that were in the Pulmonary Hypertension Center while for which is and be considered a for with the use of of of Clinical ScienceSubcategory: Therapeutic StrategiesBackground: of hypertension (PH) include of from right and heart which are at However, patients are at in this the and only higher of is a to patient and ventilation to from have been with and in the diagnosis of disease and the to Patients with PH to be to the of the which leads to in and As a result, patients require ventilation to a of with right ventricular and in patients with which ventricular and causes and of to be to of and is by in ventilation to the of the rate are as and usually by and The ventilation to is associated with the of and PH patients higher in with the in been shown to have an at and at with (Figure the to PH in patients and the This is of when to PH as as to clinical of in the of clinicians to treatment and Clinic Clinic Clinic

Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.