Heart condition in PH tied to worst hospitalization outcomes in study

Atrial fibrillation, common in PH patients, linked to 35% greater risk of death

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by Andrea Lobo |

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Atrial fibrillation or AF — a heart condition marked by an irregular heartbeat — is associated with longer hospital stays, higher inpatient mortality, and greater hospitalization costs in patients with pulmonary hypertension (PH), according to a new large-scale study.

The findings indicate that this heart condition, common in people with PH, impacts health outcomes among patients and results in a greater burden for the healthcare system.

Thus, researchers say, it’s important to identify and manage atrial fibrillation in PH patients in a timely and effective manner.

“Our findings show that there is a clear need to build our understanding of AF as a potential risk factor for more severe disease presentation and increased mortality in patients with PH,” the team wrote.

The study, “Hospital Outcomes Among Pulmonary Hypertension Patients With Atrial Fibrillation in the United States,” was published in The American Journal of Cardiology.

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PH is characterized by high blood pressure in the pulmonary arteries, the blood vessels that supply the lungs. This makes the right side of the heart work harder to pump blood, which may lead to heart problems.

AF, characterized by an irregular and often very rapid heart rate, occurs often in people with PH, leading to frequent hospital admissions and reduced quality of life. If the heart condition is not rapidly treated, it could result in poorer health outcomes.

As such, according to researchers, risk stratification and identification of people with PH who require early interventions is important to improve health outcomes and decrease healthcare costs.

“Although the [disease process] of atrial fibrillation in PH is well established, the clinical implications are yet to be completely understood,” the scientists wrote.

To date, most studies on the impact of AF in people with PH have been performed in a single center and lacked external validation.

Now, researchers in the U.S. sought to study the association between AF in hospitalized PH patients and in-hospital mortality, length of stay, and costs.

To that end, they conducted a large-scale study using data from PH patients, ages 65 and older, obtained from the U.S. National Inpatient Sample between 2005 and 2014.

Among about 5.4 million PH hospitalizations, almost half of the patients (46.6%) also had AF. These patients were significantly older — 80.4 years versus 77.9 — than those without the heart condition. Those with AF also were more likely male (38.8% vs. 36.8%), white individuals (75.1% vs. 65.5%), and Medicare beneficiaries (92.1% vs. 90.4%) than were the patients without the condition.

Hospitalizations were more frequent in large urban teaching hospitals — 45.8% among those with AF and 44.9% in the group without AF — particularly in the South.

About two-thirds of the included patients also had high blood pressure. An imbalance of fatty molecules in the blood, chronic lung disease, fluid/electrolyte disorder, and chronic kidney disease were among the most common coexisting disorders in hospitalized PH patients, each present in about 30% to 40% of patients.

The study found that patients with both PH and AF stayed significantly longer in the hospital — 4.6 vs. 3.9 days — than those without the heart condition. That led to greater hospitalization costs ($17,711 vs. $14,110) for those with both conditions.

To improve patient outcomes and decrease hospital burden, it is important to consider [atrial fibrillation] during risk stratification for patients with PH to provide timely and prompt interventions.

There also was a higher in-hospital mortality rate — 5.7% vs. 4.8% — among those with PH and AF compared with those without the heart condition.

Further analysis demonstrated that having AF increased the risk of mortality by 35%. Likewise, having both PH and AF correlated with longer hospital stays and higher hospitalization costs.

“To improve patient outcomes and decrease hospital burden, it is important to consider AF during risk stratification for patients with PH to provide timely and prompt interventions,” the researchers wrote.

Moreover, “an interdisciplinary approach should be used to account for the burden of [coexisting disorders] in this population,” they added.

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