Department of Cardiology, Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Gyeonggi, South Korea.
Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea.
BMC Pulm Med. 2019 Oct 30;19(1):189. doi: 10.1186/s12890-019-0945-0.
Limited data exists regarding healthcare utilization, medical expenses, and prognosis of pulmonary hypertension (PH) according to the World Health Organization (WHO) classification. We aimed to investigate mortality risk, healthcare utilization and medical expenditure in patients with PH across the five diagnostic subgroups.
We identified 2185 patients with PH, defined as peak tricuspid regurgitation velocity > 3.4 m/sec, among the consecutive patients referred for echocardiography between 2009 and 2015. Using diagnostic codes, medical records, and echocardiographic findings, the enrolled patients were classified according to the five subgroups by WHO classification. Healthcare utilization, costs, and all-cause mortality were assessed.
Diagnostic subgroups of PH demonstrated significantly different clinical features. During a median of 32.4 months (interquartile range, 16.2-57.8), 749 patients (34.3%) died. Mortality risk was the lowest in group II (left heart disease) and highest in group III (chronic lung disease). The etiologies of pulmonary arterial hypertension (PAH) had significant influence on the mortality risk in group I, showing the worst prognosis in PAH associated with connective tissue disease. Medical expenditure and healthcare utilization were different between the PH subgroups: groups II and V had more hospitalizations and medical expenses than other groups. Regardless of PH subgroups, the severity of PH was associated with higher mortality risk, more healthcare utilization and medical expenditure.
Significant differences in clinical features and prognostic profiles between PH subgroups reflect the differences in pathophysiology and clinical consequences. Our findings highlight the importance of comprehensive understanding of PH according to the etiology and its severity.
根据世界卫生组织（WHO）分类，关于肺动脉高压（PH）的医疗利用、医疗费用和预后的数据有限。我们旨在调查 PH 五个诊断亚组患者的死亡率风险、医疗利用和医疗支出。
我们在 2009 年至 2015 年间连续对接受超声心动图检查的患者中确定了 2185 名 PH 患者，定义为峰值三尖瓣反流速度>3.4m/sec。使用诊断代码、病历和超声心动图结果，根据 WHO 分类将纳入的患者分为五个亚组。评估了医疗利用、费用和全因死亡率。
PH 的诊断亚组表现出明显不同的临床特征。在中位数为 32.4 个月（四分位距 16.2-57.8）的随访期间，749 名患者（34.3%）死亡。组 II（心脏疾病）的死亡率风险最低，组 III（慢性肺部疾病）最高。组 I 中肺动脉高压（PAH）的病因对死亡率风险有显著影响，与结缔组织疾病相关的 PAH 预后最差。PH 亚组之间的医疗支出和医疗利用存在差异：组 II 和组 V 的住院次数和医疗费用高于其他组。无论 PH 亚组如何，PH 的严重程度与更高的死亡率风险、更多的医疗利用和更高的医疗支出相关。
PH 亚组之间的临床特征和预后特征存在显著差异，反映了病理生理学和临床后果的差异。我们的发现强调了根据病因及其严重程度全面了解 PH 的重要性。
