Patients’ mental, physical health improved during pandemic: Study
Pulmonary arterial hypertension patients report feeling 'more calm and peaceful'
Many people with pulmonary arterial hypertension (PAH) report better mental and physical health following the start of the COVID-19 pandemic, a study found.
“Unexpectedly, we found that some objective measures of pulmonary hypertension disease severity actually improved during the COVID-19 pandemic. This included longer 6-minute walk distances, lower NT-proBNP values and improved mental health scores,” the researchers wrote. NT-proBNP is a marker of heart damage.
The study, “Impact of the COVID-19 pandemic on chronic disease management and patient reported outcomes in patients with pulmonary hypertension: The Pulmonary Hypertension Association Registry,” was published in the journal Pulmonary Circulation.
The COVID-19 pandemic has had an incalculable impact on the world. In addition to the direct effects of the virus itself, the pandemic caused substantial disruption to daily life and economic systems worldwide, especially in the early phase when little was known about the virus and there were no available treatments or vaccines.
As a result, many people experienced changes in their employment and/or insurance status, which can have profound consequences for health and healthcare. Access to medical care also was disrupted during the pandemic, with many patients unable to attend planned in-person appointments due to risk of infection.
In this study, a team of researchers in the U.S. conducted an analysis aiming to better understand how the COVID-19 pandemic has affected people with PAH.
Going into the study, the researchers expected the pandemic would be associated with worse outcomes, including “higher disease severity, more frequent [emergency department] visits, longer hospital stays, and higher mortality.” They also hypothesized that after the pandemic there would be “more patients on publicly sponsored insurance, more patients unemployed, and more patients off medications.”
The analysis used data from the Pulmonary Hypertension Association Registry (PHAR) seeking to better understand, a database tracking outcomes for more than 2,000 people with pulmonary hypertension at dozens of centers across 32 states in the U.S. The PHAR was launched in 2015, and this study included data collected through 2022.
The analysis included data on a total of 1,679 people with PAH who underwent more than 6,000 clinical visits. Roughly half of these visits occurred before March 2020 (when effects of the COVID-19 pandemic first hit the U.S.), and the rest occurred after.
Results showed that PAH patients were significantly more likely to be on publicly-funded insurance (including Medicare or Medicaid) after the pandemic, by about 10%. There was a trend toward reduced employment after the pandemic hit, though this difference did not reach statistical significance when accounting for demographics (meaning that it’s mathematically plausible the trend could be due to chance).
Contrary to the researchers’ expectations, composite measures of physical and mental health improved significantly following the start of the pandemic, though the changes were close to or under the minimum clinically important difference thresholds used in other studies, the team noted.
More energy, too
“Despite the pandemic, PAH patients reported feeling more calm and peaceful, having more energy, and fewer feelings of downheartedness and depression,” the scientists wrote.
“While we do not know exactly why these improvements occurred, one possibility is patients may have had more time to focus on their health, especially if not working,” they added.
In addition, scores on the six-minute walk distance (6MWD), a common measure of exercise capacity, tended to improve after the pandemic hit, by nearly seven meters (about 20 feet) on average after controlling for other factors. Levels of NT-proBNP, a marker of heart damage, decreased significantly following the pandemic’s start.
Also contrasting the scientists’ expectations, use of healthcare services (like doctor’s visits and hospitalizations) did not significantly change after the pandemic hit.
“Our study did not find evidence of a significant change in the odds of being off medications during the COVID-19 pandemic,” the researchers wrote.
A potential explanation for this finding, the researchers said, is that people in the PHAR already have established relationships with their specialty healthcare providers. This may have dampened the negative impacts of the pandemic and facilitated quick adaptation, they speculated.
Another potential explanation might be that patients with more substantial problems following the pandemic may have been less likely to continue participating in the registry, which the researchers noted as a limitation of the analysis.
There was a higher rate of mortality after the pandemic hit, though this increase was less after the researchers made mathematical adjustments to account for differences in other factors like age, sex, race, and education.
“We found that PHAR patients had a higher probability of death during the pandemic, before adjusting for demographics. However, when adjusting for demographics, this effect was attenuated and was not found to be statistically significant,” the researchers wrote.
They noted that patients on public insurance tended to have a worse 6MWD, more emergency room visits, and longer hospitalizations, both before and after the pandemic.
“Irrespective of the COVID-19 pandemic, patients who were on publicly-sponsored insurance seemed to do worse,” they wrote, noting that this finding is consistent with previous research on social determinants (nonmedical factors) of health.