Delayed Diagnosis, More Comorbidities Affect Elderly PH Patients’ Prognosis, Study Suggests

Alice Melão, MSc avatar

by Alice Melão, MSc |

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Older patients diagnosed with pulmonary hypertension (PH) present a specific clinical profile and have a worse prognosis, a study shows. Given this, a patient’s age should be taken into account when diagnosing PH, researchers suggest.

The study, “Impact of comorbidities and delay in diagnosis in elderly patients with pulmonary hypertension,” was published in the journal ERJ Open Research.

Several studies have evaluated the demographics and clinical presentation of PH. However, many of these are focused on the pulmonary arterial hypertension (PAH) subtype, while information about other subtypes of the disease is scarce.

To have a broader view of this life-threatening disease, French researchers reviewed the clinical records of 248 patients diagnosed with PH related to different illnesses.

The participants’ median age at diagnosis was 68. Approximately 33.1% of the participants were diagnosed when they were 65-74 (elderly group), and 26.2% were very elderly (75 or older) when they received their diagnosis. About 40.7% of the participants were under 65.

Almost half the participants (45.6%) had been diagnosed with PAH.

PAH was the most common type of PH among younger patients (younger than 65 at diagnosis), whereas elderly and very elderly patients often had PH associated with a respiratory disease. Among the very elderly patients, 24.6% had chronic thromboembolic pulmonary hypertension (CTEPH).

The team found that older patients had a longer delay in access to a regional referral PH center than patients younger than 74. Furthermore, while the younger group’s mean time to diagnosis was seven months, elderly and very elderly patients had to wait nine and 16 months on average, respectively.

At the time of the first evaluation at the PH center, elderly and very elderly patients had lower pulmonary arterial pressure and pulmonary vascular resistance than younger patients. Very elderly patients (75 or older) were found to have lower cardiac index, suggesting that age was associated with poorer heart-pumping potential.

The median overall survival of the patient cohort was 46 months. When looking at groups according to age, elderly patients had a median survival of 37 months; the very elderly, 28 months.

Median survival decreased with age, with very elderly patients showing survival rates of 65%, 59%, and 40% at one, two, and three years after the diagnosis, compared to 81%, 71%, and 57%, respectively in the total cohort.

However, when survival rates were adjusted based on comorbidities, no differences were found among age groups.

Therefore, the team believes that the poor outcome of the elderly PH population could be partially explained by the higher prevalence of comorbidities, such as altered arterial hypertension, coronary artery disease, and cardiac arrhythmias.

In addition, researchers found that male patients, those who had group 3 PH, reduced exercise capacity, and a history of stroke, chronic obstructive pulmonary disease (COPD), or cognitive disorders had a higher risk of death.

“Patient age should be taken into account when diagnosing pulmonary hypertension as it is associated with a specific clinical profile and a worse prognosis,” researchers stated. “The long-term survival is worse for elderly and very elderly patients than for their younger counterparts. This difference is likely to be related to a longer delay in diagnosis and a higher burden of comorbidities.”