PAH-related heart failure is becoming more common: Analysis
Researchers suggest focus on disease management, earlier diagnosis
Heart failure related to pulmonary arterial hypertension (PAH) is becoming more common, with patients living fewer years in full health, a trend that’s predicted to continue, with more cases and deaths expected by 2050, a study showed.
In the three decades from 1990 to 2021, women accounted for more cases of PAH than men, suggesting that future efforts should focus on better understanding sex-specific differences and tailoring interventions. However, age-standardized prevalence rates, which adjust the number of cases by accounting for differences in age, appear to be decreasing.
“The decrease in prevalence rates despite increasing numbers might be attributed to improved case detection, earlier diagnosis, and enhanced treatment strategies, leading to better disease management,” the researchers wrote.
The study, “Global Burden of Pulmonary Arterial Hypertension and Associated Heart Failure: Global Burden of Disease 2021 Analysis,” was published in JACC: Heart Failure based on data from the Global Burden of Disease, a resource to understand the health challenges faced by people across the world.
In PAH, the pulmonary arteries that take blood from the right side of the heart to the lungs narrow, increasing blood pressure. This makes it hard for the heart to pump enough blood through to the lungs, leading to symptoms such as shortness of breath. Left untreated, it can lead to heart failure.
Disease prevalence steady, higher rate of new cases
To understand how PAH and PAH-related heart failure have changed over time from 1990 to 2021, a team of researchers in China drew on data from the Global Burden of Disease 2021 database. The goal was to track trends at global, regional, and national levels and predict how the disease will evolve until 2050.
To do this, the researchers focused on how many people have the disease (prevalence), how many new cases occur (incidence), and how many people die from it. They also calculated disability-adjusted life years (DALYs), a measure of disease burden expressed as the number of years lost due to disability.
From 1990 to 2021, the global prevalence of PAH stayed stable (2.3-2.28 cases per 100,000 people), but incidence increased slightly (0.5-0.52 cases per 100,000 people). While death rates decreased significantly, population growth and aging contributed to an increase in the total number of deaths. The researchers noted, however, that all these trends showed variations over time.
While the number of cases of PAH increased for men and decreased for women, the disease was still more common in women. The number of DALYs and deaths decreased in both men and women, but more so in men, meaning that by 2021, women “surpassed men in DALYs and deaths rates,” the team wrote.
The greatest increase in PAH prevalence was observed in regions of low to middle sociodemographic index (SDI), a measure of development based on income, education, and birth rates. The deepest reductions in DALYs and death rates occurred in regions of high-middle SDI.
“At the regional level, Western Sub-Saharan Africa and Central Latin America reported rising prevalence rates … and Central Sub-Saharan Africa showed the largest decline,” the researchers wrote.
During the same time window, the total number of cases of PAH-related heart failure nearly doubled from 105,703 to 191,808 across the world, and years lived with disability increased from 9,789 to 17,765. Prevalence rates decreased slightly in women but increased in men.
In 2021, PAH-related heart failure was most common in regions with high and high-middle SDI. The number of years lived with disability was highest in regions with middle SDI. Western sub-Saharan Africa saw notable increases in both prevalence and years lived with disability.
“Our investigation into the global burden of PAH from 1990 to 2021 reveals that despite reduced or stable [age-standardized rates], the overall impact of PAH—measured by prevalence, incidence, mortality, and related [heart failure]—has escalated,” the team wrote.
The results also “underscore the global nature of the PAH-related [heart failure] burden, with significant and growing impacts in low-middle and middle SDI regions,” wrote the researchers, who noted that “access to advanced therapies, particularly pulmonary vasodilator treatments, remains largely concentrated in North America and Western Europe.”
The prevalence and incidence of PAH, as well as the number of deaths, are expected to increase by 2050 due to population growth and aging, so “prevention and control strategies should focus on managing elderly patients through multidisciplinary and individualized treatment approaches,” the researchers wrote. “Countries across the various SDIs should prioritize PAH prevention, prompt diagnosis, and integrated management to help control the disease’s escalating impact.”
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