Trammell Aaron W, Shah Amit J, Phillips Lawrence S, Michael Hart C
1 Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA.
2 Atlanta VA Medical Center, Decatur, Georgia, USA.
Pulm Circ. 2019 Jan-Mar;9(1):2045894019825763. doi: 10.1177/2045894019825763.
Pulmonary hypertension (PH) occurs when the pulmonary vasculature is itself diseased or becomes affected secondarily by comorbid conditions, commonly left heart or lung disease. The high prevalence of chronic cardiopulmonary conditions among patients served by Veterans Health Administration (VHA) suggests this population may be particularly susceptible to PH. We sought to identify clinical features and outcomes in veterans diagnosed with PH. We utilized the VHA Corporate Data Warehouse to identify veterans diagnosed between January 1, 2003 and September 30, 2015, assess relevant patient characteristics and their survival time. The effects of PH subtype and baseline factors on outcome were estimated by Cox modeling. There were 110,564 veterans diagnosed with PH during the study period. These veterans were predominantly male, had median age 70.2, and had a high burden of comorbid conditions. PH was frequently due to left heart and/or lung disease. Average survival after PH diagnosis was 3.88 years. Compared with other types, PH due to left heart disease, lung disease or both had shorter survival. This large retrospective study of veterans demonstrates the significance of PH due to left heart and/or lung disease which was common and had high risk of death. Multi-comorbidity was common and added to risk. These findings underscore the need for risk assessment tools for subjects with non-Group 1 PH and novel management strategies to improve their outcome. This study details the largest retrospective cohort assembled for evaluation of secondary PH and allows hypothesis-generating inquiries into these common conditions that are rarely prospectively studied.
当肺血管本身患病或继发于合并症（通常为左心或肺部疾病）而受到影响时，就会发生肺动脉高压（PH）。退伍军人健康管理局（VHA）服务的患者中慢性心肺疾病的高患病率表明，这一人群可能特别容易患肺动脉高压。我们试图确定被诊断为肺动脉高压的退伍军人的临床特征和预后。我们利用VHA企业数据仓库来识别2003年1月1日至2015年9月30日期间被诊断为肺动脉高压的退伍军人，评估相关患者特征及其生存时间。通过Cox模型估计肺动脉高压亚型和基线因素对预后的影响。在研究期间，有110,564名退伍军人被诊断为肺动脉高压。这些退伍军人主要为男性，年龄中位数为70.2岁，合并症负担较重。肺动脉高压常由左心和/或肺部疾病引起。肺动脉高压诊断后的平均生存期为3.88年。与其他类型相比，由左心疾病、肺部疾病或两者引起的肺动脉高压生存期较短。这项针对退伍军人的大型回顾性研究表明，由左心和/或肺部疾病引起的肺动脉高压具有重要意义，这种情况很常见且死亡风险高。多重合并症很常见，增加了风险。这些发现强调了对非1组肺动脉高压患者进行风险评估工具的必要性，以及采用新的管理策略来改善其预后。这项研究详细介绍了为评估继发性肺动脉高压而组建的最大规模回顾性队列，并允许对这些很少进行前瞻性研究的常见情况进行假设性探究。
