PAH hospitalizations becoming less common but more costly
medwireNews: Pulmonary arterial hypertension (PAH)-related hospitalization rates have fallen significantly in the USA since 2001, but the cost of each hospitalization has risen substantially and is increasingly paid for by Medicare, study findings indicate.
The cross-sectional study of the US National Inpatient Sample database showed that the annual number of PAH-related hospitalizations in adults decreased by a significant 58% from 3177 in 2001 to 1345 in 2012.
This finding “likely reflects an overall improvement in the outpatient care of these patients and likely favorable disease course with the availability of PAH-specific vasodilator therapies,” Thenappan Thenappan (University of Minnesota School of Medicine, Minneapolis, USA) and study co-authors remark.
By contrast, the mean hospital charge per admission increased 2.7-fold, from US$ 29,507 (€ 27,816) in 2001 to US$ 79,607 (€ 75,044) in 2012, and was still 2.1-fold higher after accounting for inflation.
The researchers suggest the increasing costs, which were paid for by Medicare in half of cases in 2012, are driven by the use of expensive PAH-specific vasodilator therapies during admission, and the fact that the hospitalized patients are more frequently acutely ill and have increasing comorbidities.
Indeed, rates of diabetes, hypertension, coronary artery disease, chronic obstructive pulmonary disease, anemia, cardiac dysrhythmias, congestive heart failure, acute or chronic kidney disease, fluid and electrolyte imbalance, pneumonia, cardiogenic shock, and acute respiratory failure all increased significantly among PAH patients from 2001 through 2012.
In spite of this, in-hospital mortality among patients with PAH remained more or less unchanged over time, at 7.8% in 2001 and 6.3% in 2012.
Thenappan et al write in JAMA Cardiology that the persistently high mortality rates highlight “the need to better understand and improve management of acute right heart failure and other critical illnesses in patients with PAH.”
The researchers also observed a small but significant increase in the average length of hospital stay, from 7.0 days in 2001 to 7.6 days in 2012, which they say may be due to the fact that PAH is a rare disease and “treatment of patients critically ill with PAH symptoms, especially acute right heart failure, is mainly based on consensus rather than evidence-based recommendations.”
Admission to a teaching hospital, cardiac dysrhythmia, acute kidney injury, acute cerebrovascular accident, and acute respiratory failure were all significantly associated with both increased length of hospitalization and in-hospital mortality. However, congestive heart failure, cardiogenic shock, and fluid and electrolyte imbalance were only associated with increased in-hospital mortality.
“Taken together, these data highlight the increasing clinical and economic burden of PAH-related hospitalizations and should help identify patients with PAH who are at increased risk of prolonged hospitalization and in-hospital mortality,” Thenappan and co-authors conclude.
By Laura Cowen
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