Stroke With PH Can Lead to Longer Hospital Stays, Greater Risk for Men

Pulmonary hypertension (PH) increases the likelihood of a prolonged hospitalization following an acute ischemic stroke, or a stroke due to a blocked vessel carrying blood to a part of the brain, according to a large U.S. database study.

Men with PH and such a stroke are also 31% more likely to die while hospitalized than are women with PH in the same situation, and patients older than age 70 are less likely than younger ones to be routinely discharged, its researchers wrote.

The study, “Sex Differences in Ischemic Stroke Outcomes in Patients With Pulmonary Hypertension,” was published in the Journal of the American Heart Association.

PH, which is characterized by high blood pressure in the vessels that supply blood to the lungs, is known to increase the risk of acute ischemic stroke.

However, the impact of PH on outcomes among patients hospitalized after an acute ischemic stroke is not fully known.

Researchers at the University of Aberdeen, in the U.K., and their colleagues investigated the link between PH and in-hospital outcomes after an acute ischemic stroke. They also assessed whether sex plays a role, since PH is known to affect mostly women, yet men can have poorer outcomes.

Data came from the U.S. National Inpatient Sample, a large public database that includes nationwide hospital admission records, collected from October 2015 to December 2017.

Researchers analyzed 221,249 cases of acute ischemic stroke, corresponding to 1.1 million hospitalized patients (median age of 72; 50.41% women). A total of 31,830 of these patients (2.88%) had a PH diagnosis: 155 (0.49%)  with pulmonary arterial hypertension (PAH), 17,210 (54.07%) with PH and co-existing left heart disease, and 5,370 (16.87%) with PH and co-existing left heart disease and chronic lung disease.

Those with PH were significantly older than patients without the disease (median age of 80 vs. 71) and the majority, 64.66%, were women (49.99% were women in the overall stroke population). People with PH had significantly longer hospital stays and were more likely to have co-existing conditions — including atrial fibrillation, a form of irregular heartbeat (56.83% vs. 24.58%) — than those without PH.

PH patients were also more likely to undergo treatments to dissolve clots in blood vessels, to improve blood flow.

In-hospital mortality was higher in the PH group (6.52%) than among people without PH (3.86%). A higher proportion of PH patients also had an extended hospitalization, defined as a stay lasting more than four days — 48.71% vs. 33.99% — and this difference in length was found to be significant. In addition, routine home discharges were less frequent in the PH group (21.83%) than among stroke patients without  PH (37.54%).

Among these 31,830 patients with PH and a stroke, 11,250 were men (35.34%). Compared with women, men with PH were significantly younger when they had this stroke — median age of 76 vs. 82 in women.

Further analysis linked PH with a 15% increased risk for in-hospital mortality among men, although this result was not statistically significant. When comparing the PH groups by sex, men were 31% more likely to die during hospitalization than were women.

Age was also a factor, with older patients being less likely to be discharged home than their younger counterparts.

These results suggest that “while PH was not overall associated with in-hospital mortality, it was associated with increased odds of prolonged hospitalization and adverse discharge status after AIS [acute ischemic stroke],” the researchers wrote.

“Further studies assessing postdischarge outcomes in the medium and long term after AIS are required to fully characterize the relationship between PH and AIS,” they added.

Among study limitations were a lack of data related to the severity of a person’s PH and stroke, the researchers noted.