Outcomes Better for PAH Patients Treated at Specialty Centers, Study Finds
People with pulmonary arterial hypertension (PAH) who are treated at specialty care centers have better survival chances and a lower likelihood of hospitalization, a study reports.
These findings support referring PAH patients to specialty care centers for treatment, where factors like more careful disease monitoring might be decisive.
The study, “Outcomes of Pulmonary Arterial Hypertension Are Improved in a Specialty Care Center,” was published in the journal CHEST.
Current guidelines suggest that PAH care be administered at care centers specialized in treating the disease. However, published data concerning whether a specialty care center improves treatment outcomes are limited.
A team of researchers analyzed data collected from the University of Pittsburgh Medical Center (UPMC) medical system, which includes both specialty and non-specialty care centers. This allowed researchers to compare outcomes for patients treated at either type of center in the same geographic area.
In total, researchers analyzed data from 580 PAH patients, of whom 455 (78%) were managed at a specialty center.
Patients seen at specialty centers were younger — a median age 58.8 vs. 64.8 years in the group treated at non-specialty care centers — and more likely to be female — 68.4% vs. 51.2% among non-specialty treated patients. They also had more comorbidities, including hypertension and obesity.
No significant racial or economic differences were evident between the groups, and no significant differences in how far away patients lived from the respective center.
By some indices, but not others, patients seen at a specialty center had more severe PAH. For instance, those seen at the specialty center had significantly higher mean pulmonary arterial pressure (45 vs. 40.5 mm Hg), whereas the two groups had similar pulmonary vascular resistance.
After adjusting data for factors like age, sex, lung transplant status, and comorbidities, results showed that patients who went to a specialty center were 32% less likely to die relative to those treated at a non-specialty care center. Significant increases in survival were seen in both sexes.
Specialty care centers also had fewer hospital admissions. This difference was statistically significant for the overall group and for females, but it was not significant for males.
Of note, 58 patients (12.7%) were seen only once at a specialty center. The above differences remained significant when these patients were re-classified as non-specialty center patients.
PAH is typically managed with vasodilators, medicines that cause blood vessels to widen, decreasing blood pressure. Patients managed at a specialty center were significantly more likely to be prescribed a vasodilator (80.7%) than those at non-specialty centers (34.7%).
While vasodilator use was associated with significant improvements in survival, in statistical models the use of vasodilators did not fully account for the differences in outcomes between the two types of care.
“These data emphasize the importance of vasodilator use in improving outcomes across both cohorts. However, vasodilator use alone did not explain the entirety of benefits observed in SCC [specialty care center] patients,” the researchers wrote.
Lung transplants were performed at similar rates in patients seen at specialty and non-specialty care centers, so this form of treatment also did not explain the differences in clinical outcomes.
“This supports the importance of other factors, such as more frequent disease monitoring, to drive additional outcome improvements in SCC patients,” the team wrote. In keeping with this idea, testing of lung function, as well as functional tests like the six minute walk test, were performed significantly more frequently in specialty centers.
“Our data indicate that PAH care at an SCC was associated with improvements in all-cause mortality and hospitalization. Although some of SCC benefits are likely derived from increased vasodilator use, differences in management strategies with increased guideline compliance may also contribute,” the researchers concluded.
“These findings provide crucial support for more robust referral to SCCs and collaboration with the community,” the team added.