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A comprehensive risk stratification at early follow-up determines prognosis in pulmonary arterial hypertension
Lund Univ, Cardiol, Dept Clin Sci Lund, Lund, Sweden; Skåne Univ Hosp, VO Heart & Lung Med, Sect Heart Failure & Valvular Dis, Lund, Sweden.
Karolinska Inst, Dept Med Solna, Cardiol Unit, Stockholm, Sweden.
Univ Gothenburg, Sahlgrenska Acad, Dept Cardiol, Gothenburg, Sweden; Sahlgrens Univ Hosp, Gothenburg, Sweden.ORCID-id: 0000-0002-2395-8989
Linköping Univ, Inst Med & Hlth Sci, Dept Cardiol, Linköping, Sweden; Linköping Univ, Inst Med & Hlth Sci, Dept Clin Physiol, Linköping, Sweden.
Vise andre og tillknytning
2018 (engelsk)Inngår i: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 39, nr 47, s. 4175-4181Artikkel i tidsskrift (Fagfellevurdert) Published
Abstract [en]

Aims: Guidelines recommend a goal-oriented treatment approach in pulmonary arterial hypertension (PAH). The aim is to reach a low-risk profile, as determined by a risk assessment instrument. This strategy is incompletely validated. We aimed to investigate the bearing of such risk assessment and the benefit of reaching a low-risk profile.

Methods and results: Five hundred and thirty PAH patients were included. Follow-up assessments performed after a median of 4 (interquartile range 3–5) months were available for 383 subjects. Patients were classified as ‘Low’, ‘Intermediate’, or ‘High risk’ and the benefit of reaching the ‘Low risk’ group was estimated. Survival differed (P < 0.001) between the risk groups at baseline and at follow-up. Survival was similar for patients who remained in or improved to the ‘Low risk’ group. Survival was similar for patients who remained in or worsened to the ‘Intermediate risk’ or ‘High risk’ groups. Irrespective of follow-up risk group, survival was better (P < 0.001) for patients with a higher proportion of variables at low risk. Results were unchanged after excluding patients with idiopathic PAH >65 years at diagnosis, and when patients with idiopathic or connective tissue disease-associated PAH were analysed separately. Patients in the ‘Low risk’ group at follow-up exhibited a reduced mortality risk (hazard ratio 0.2, 95% confidence interval 0.1–0.4 in multivariable analysis adjusted for age, sex and PAH subset), as compared to patients in the ‘Intermediate risk’ or ‘High risk’ groups.

Conclusion: These findings suggest that comprehensive risk assessments and the aim of reaching a low-risk profile are valid in PAH.

sted, utgiver, år, opplag, sider
2018. Vol. 39, nr 47, s. 4175-4181
Emneord [en]
Prognosis, Survival, Goal-oriented treatment, Guidelines, PAH
HSV kategori
Identifikatorer
URN: urn:nbn:se:uu:diva-377378DOI: 10.1093/eurheartj/ehx257ISI: 000456854500010PubMedID: 28575277OAI: oai:DiVA.org:uu-377378DiVA, id: diva2:1291437
Forskningsfinansiär
Eli Lilly and CompanyGlaxoSmithKline (GSK)Swedish Association of Local Authorities and RegionsTilgjengelig fra: 2019-02-25 Laget: 2019-02-25 Sist oppdatert: 2019-02-25bibliografisk kontrollert

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