Bouzina Habib, Rådegran Göran, Butler Oisin, Hesselstrand Roger, Hjalmarsson Clara, Holl Katsiaryna, Jansson Kjell, Klok Rogier, Söderberg Stefan, Kjellström Barbro
Department of Clinical Sciences Lund, Cardiology, Faculty of Medicine and Hemodynamic Lab, Section for Heart Failure and Valvular Disease, VO. Heart and Lung Medicine, Lund University, Skåne University Hospital, Lund, Sweden.
Bayer AG, Berlin, Germany.
ESC Heart Fail. 2021 Feb;8(1):680-690. doi: 10.1002/ehf2.13162. Epub 2020 Dec 10.
Low-risk status in pulmonary arterial hypertension (PAH) predicts better survival. The present study aimed to describe changes in risk status and treatment approaches over multiple clinical assessments in PAH, taking age and comorbidity burden into consideration.
The study included incident patients from the Swedish PAH registry, diagnosed with PAH in 2008-2019. Group A (n = 340) were ≤75 years old with <3 comorbidities. Group B (n = 163) were >75 years old with ≥3 comorbidities. Assessments occurred at baseline, first-year (Y1) and third-year (Y3) follow-ups. The study used an explorative and descriptive approach. Group A: median age was 65 years, 70% were female, and 46% had no comorbidities at baseline. Baseline risk assessment yielded low (23%), intermediate (66%), and high risk (11%). Among patients at low, intermediate, or high risk at baseline, 51%, 18%, and 13%, respectively, were at low risk at Y3. At baseline, monotherapy was the most common therapy among low (68%) and intermediate groups (60%), while dual therapy was the most common among high risk (69%). In patients assessed as low, intermediate, or high risk at Y1, 66%, 12%, and 0% were at low risk at Y3, respectively. Of patients at intermediate or high risk at Y1, 35% received monotherapy and 13% received triple therapy. In low-risk patients at Y1, monotherapy (40%) and dual therapy (43%) were evenly distributed. Group B: median age was 77 years, 50% were female, and 44% had ≥3 comorbidities at baseline. At baseline, 8% were at low, 80% at intermediate, and 12% at high risk. Monotherapy was the most common therapy (62%) in Group B at baseline. Few patients maintained or reached low risk at follow-ups.
Most patients with PAH did not meet low-risk criteria during the 3 year follow-up. The first year from diagnosis seems important in defining the longitudinal risk status.
肺动脉高压（PAH）的低风险状态预示着更好的生存率。本研究旨在描述PAH患者在多次临床评估中的风险状态变化及治疗方法，并考虑年龄和合并症负担。
该研究纳入了瑞典PAH登记处2008 - 2019年诊断为PAH的初发患者。A组（n = 340）年龄≤75岁，合并症<3种。B组（n = 163）年龄>75岁，合并症≥3种。评估在基线、第一年（Y1）和第三年（Y3）随访时进行。本研究采用探索性和描述性方法。A组：中位年龄为65岁，70%为女性，46%在基线时无合并症。基线风险评估显示低风险（23%）、中风险（66%）和高风险（11%）。在基线时处于低、中或高风险的患者中，分别有51%、18%和13%在Y3时处于低风险。在基线时，单药治疗是低风险组（68%）和中风险组（60%）中最常见的治疗方法，而双联治疗在高风险组中最常见（69%）。在Y1时评估为低、中或高风险的患者中，分别有66%、12%和0%在Y3时处于低风险。在Y1时处于中或高风险的患者中，35%接受单药治疗，13%接受三联治疗。在Y1时的低风险患者中，单药治疗（40%）和双联治疗（43%）分布均匀。B组：中位年龄为77岁，50%为女性，44%在基线时合并症≥3种。在基线时，8%为低风险，80%为中风险，12%为高风险。单药治疗是B组基线时最常见的治疗方法（62%）。很少有患者在随访时维持或达到低风险。
大多数PAH患者在3年随访期间未达到低风险标准。从诊断开始的第一年似乎对确定纵向风险状态很重要。
